Standard versus bolus photodynamic therapy in circumscribed choroidal hemangioma: functional outcomes

PURPOSE. To compare standard versus bolus photodynamic therapy (PDT) in the treatment of symptomatic circumscribed choroidal hemangioma (CCH). METHODS. Twenty consecutive cases of CCH were included in this prospective randomized study. Each patient was randomly assigned to receive either standard PDT (10-minute 6 mg/mq(2) verteporfin infusion; treatment at 15 min; 50 J/cm(2); 83 s) or bolus PDT (6 mg/mq(2) verteporfin infusion bolus in 1 min; treatment at 5 min; 100 J/cm(2); 166 s). Best-corrected visual acuity (BCVA), fundus photography, optical coherence tomography, fluorescein, and indocyanine green angiography were performed at baseline and during follow-up. Retinal sensitivity was tested with microperimetry before and after treatment. Follow-up was longer than 32 months. RESULTS. Mean follow-up was 58 11 months. All cases (100%) showed clinical regression of the treated lesion. Neuroretinal and retinal pigment epithelium (RPE) changes were found in 9(90%) bolus PDT over treated area. No similar RPE changes were found in patients treated with standard PDT There was a no statistically significant difference in BCVA outcome between the 2 groups (p=0.078). Microperimetry revealed reduced sensitivity over the treated area in 7 bolus PDT vs 1 in standard treated eyes (p=0.008). CONCLUSIONS. Both standard and bolus PDT induce regression of symptomatic CCH. Bolus PDT may cause RPE and retinal changes associated with reduced retinal sensitivity.