Treatment Outcome of Serous Macular Detachment in Circumscribed Choroidal Hemangioma

Jeong Min; Seung Min Lee; Han Jo Kwon; Sung Who Park; Ji Eun Lee; Ik Soo Byon

doi:10.3341/jkos.2017.58.3.289

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Min, Lee, Kwon, Park, Lee, and Byon: Treatment Outcome of Serous Macular Detachment in Circumscribed Choroidal Hemangioma

Original Article

J Korean Ophthalmol Soc 2017;58(3):289-295.

Published online: 7 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.3.289

Treatment Outcome of Serous Macular Detachment in Circumscribed Choroidal Hemangioma

Jeong Min, MD¹, Seung Min Lee, M.D.¹, Han Jo Kwon, M.D.², Sung Who Park, MD^2,³, Ji Eun Lee, MD, PhD², Ik Soo Byon, MD, PhD^1,^3,

¹Research Institute for Convergence of Biomedical Science and Technology, Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea

²Medical Research Institute, Department of Ophthalmology, Pusan National University Hospital, Busan, Korea

³Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea

Address reprint requests to Ik Soo Byon, MD Department of Ophthalmology, Pusan National University Yangsan Hospital, #20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: 82-55-360-2592, Fax: 82-55-360-2161 E-mail: isbyon@pusan.ac.kr

Received 1 September 201625 January 2017 Accepted 1 March 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To determine the clinical outcome of anti-vascular endothelial growth factor (anti-VEGF) and photodynamic therapy (PDT) for circumscribed choroidal hemangioma (CCH) with serous retinal detachment.

Methods

The medical records of patients having CCH with serous retinal detachment in macula were retrospectively reviewed. CCH and serous retinal detachment were evaluated via fundus photography, optical coherence tomography, indocyanine green angiography, and ultrasonography.

Results

A total of 9 eyes were enrolled in this study. The average follow-up period was 19.2 months. The mean visual acuity was 0.51 ± 0.52 (logMAR) and the mean maximum diameter and thickness of the tumor were 6,154.4 ± 2,019.9 μ m and 2,224.4 ±862.1 μ m, respectively. Of the 6 eyes receiving anti-VEGF (mean number of injections: 3.16) as the first treatment for serous reti-nal detachment, 5 had sustained or recurred intraretinal/subretinal fluid (IRF/SRF) and needed additional PDT and transpupillary thermotherapy. In the 3 eyes that received PDT (mean number of treatments: 1.3) as an initial treatment, IRF/SRF was com-pletely resolved. Finally, 8 eyes achieved complete resolution of SRF and IRF; however visual recovery was limited.

Conclusions

PDT, even with a small number of treatments, can alleviate IRF/SRF in CCH, while anti-VEGF did not. J Korean Ophthalmol Soc 2017;58(3):289-295

Keywords: Circumscribed choroidal hemangioma, Serous retinal detachment, Photodynamic therapy

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Figure 1.

Representative case 4 having an exudative retinal detachment in circumscribed choroidal hemangioma (CCH). (A) At the presentation, fundus photograph showed that an orange colored CCH at the supero-nasal macula in the left eye. Indocyanine green angiography and ultrasonography showed CCH at the same location. Optical coherence tomography showed subretinal fluid (SRF) at the macula. The central macular thickness was 542 μ m and visual acuity was 0.4 (logMAR). The maximum diameter and thick-ness of the tumor was 2,840 μ m and 1,210 μ m, respectively. (B) Six months after intravitreal bevacizumab injection, SRF did not change. Visual acuity was 0.4. (C) Two months after photodynamic therapy, SRF disappeared, macualr thickness decreased to 204 μ m and visual acuity increased to 0.1. Exduative retinal detachment did not recur during 9 months follow-up period.

Figure 2.

Representative case 9 having an exudative retinal detachment in circumscribed choroidal hemangioma (CCH). (A) At the presentation, fundus photograph showed that an orange colored CCH at the infero-nasal macula in the right eye. Indocyanine green angiography and ultrasonography showed CCH at the same location. Optical coherence tomography showed intraretinal and sub-retinal fluid (intraretinal fluid [IRF]/subretinal fluid [SRF]) at the macula. The central macular thickness was 400 μ m and visual acuity was 0.2 (logMAR). The maximum diameter and thickness of the tumor was 7,910 μ m and 2,830 μ m, respectively. (B) Two months after photodynamic therapy, IRF/SRF disappeared, central macular thickness decreased to 220 μ m but visual acuity did not changed. Exudative retinal detachment did not recur during 10 months follow-up period.

Table 1.

Patients’ characteristics

Sex	Age (years)	Follow up (months)	Treatment (2nd treatment)	BCVA (logMAR)		SRF		IRF		Tumor size (μ m)
Sex	Age (years)	Follow up (months)	Treatment (2nd treatment)	Initial	Final	Initial	Final	Initial	Final	Width	Thickness
1 F	54	26	Anti-VEGF, (PDT)	0.4	0.3	+	-	-	-	7,810	1,450
2 M	44	43	Anti-VEGF, (TTT)	0.2	0.4	+	-	-	-	5,400	2,760
3 F	49	33	Anti-VEGF, (PDT)	0.1	0	+	-	-	-	4,310	1,320
4 M	34	18	Anti-VEGF, (PDT)	0.4	0.1	+	-	-	-	2,840	1,210
5 M	53	11	Anti-VEGF, (PDT)	1.4	1.4	+	+	+	+	5,020	1,760
6 F	68	9	Anti-VEGF	1.4	1.7	+	-	-	-	8,620	2,980
7 M	60	14	PDT	0.1	0.2	+	-	-	-	5,360	2,060
8 F	56	12	PDT	0.4	0.1	+	-	+	-	8,120	3,650
9 M	44	7	PDT	0.2	0.2	+	-	-	-	7,910	2,830

BCVA = best corrected visual acuity; SRF = subretinal fluid; IRF = intraretinal fluid; F = female; M = male; Anti-VEGF = anti-vascular endothelial growth factor; PDT = photodynamic therapy; TTT = transpupillary thermotherapy.

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