EyeRounds Online Atlas of Ophthalmology
Contributor:
Greg Zablocki, Retina Consultants of Colorado, P.C.
Category: Retina
Diagnosis: Choroidal Hemangioma
Image Comments:
Abstract
Aim: Establish efficiency of PDT with a symptomatic choroidal hemangioma.
Design: Single case study
Methods: A patient with a symptomatic choroidal hemangioma was treated using PDT. Follow up with OCT was accomplished in order to establish success of treatment.
Results: Patient showed clearing of subretinal fluid, resolution of retinal detachment, and improvement of their visual acuity.
Patient came presenting signs and symptoms of a choroidal hemangioma, Her symptoms were reduced vision and a oval central scotoma in the vision of the right eye for two months. FA showed hyper-fluorescence of the region, and OCT showed subretinal fluid underlying the macula. Photodynamic therapy was the chosen as the means of treatment for its high probability of success in treatment of choroidal hemangiomas.
Examination
Visual Acuity: Distance VA Chief Complaint: OD: 20/70+1 ph NI OS: 20/25
IOP: OD: 16mmHg OS: 14mmHg @ 12:58PM (tonometer used: Goldmann applanation)
Confrontation visual field: OU: Normal
Motility: OU: Normal
Pupils: OD: pharmacologically dilated
OS: Shape, size, direct and consensual reaction normal
Adnexa: R: Preauricular LN, lacrimal drainage, lacrimal glands, orbit normal
Eye Lids: normal
Dilation: OU: Tropicamide 0.8% Phenylephrine 5% @ 12:58PM
Extended Ophthalmoscopy:
OD: subretial fluid extending into from a lobular, flesh colored lesion superior to the right optic nerve (figure 1)
OS normal
Systemic Evaluation generally negative including for primary carcinoma
Treatment and Course
The patient underwent photodynamic therapy employing the technique of Michels et al 1. After infusion of 6mg/m2 of verteporfin (Visudyne) intravenously the lesion was illuminated for 163 seconds with the activating laser Two months later vision had improved from 20/70 to 20/30 and the sub-retinal fluid had resorbed clinically and on OCT (figure 5)
Conclusions: Case supports referenced findings that PDT is a safe and effective treatment of choroidal hemangioma.
1. Verteporfin therapy for choroidal hemangioma: a long-term follow-up, Michels, et al Retina. 2005 Sep25(6):697-703.
Figure 2 - The fleshy, lobular sub-retinal lesion from Figure 1 shows early phases of flourescein angiograph with hyperflourescence within the lesion (Dye persisted within the lesion 20 minutes after injection
Figure 3 - Optical coherence tomography (OCT) section through the macula demonstrating sub-retinal fluid prior to treatment. Visual acuity 20/70.
Figure 4 - OCT eight months after treatment showing complete resobtion of fluid - visual acuity 20/30.
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