Abstract
Background
The aim of this retrospective study was to determine the efficacy of proton beam irradiation in choroidal hemangioma in a long-term follow-up.
Patients and methods
A total dose of 20 Cobalt Gray equivalent (CGE) was administered to 50 eyes of 50 patients from September 1998 to September 2010. All treated patients presented with a symptomatic tumor. Nine patients were pre-treated by photodynamic therapy (PDT). Visual outcome, tumor regression, and complications resulting from radiation were investigated.
Results
The mean follow-up was 55.4 months (range 13–132). Tumor thickness decreased in all patients. Retinal re-attachment was achieved without evidence of tumor leakage. Visual acuity improved by two lines after one year in 43.4 % of patients and after two years in 36.8 % of patients. During the 55.4 months of long-term follow-up the visual acuity improved from 6/15 to 6/12 after proton therapy. Twenty-three patients (46.0 %) developed radiation retinopathy. According to the Finger classification of 2004, 21 patients (42.0 %) showed a stage 1 or 2 (functionally not relevant) retinopathy, and two patients (4.0 %) presented a stage 3 or 4 (functionally relevant) retinopathy. Further complications included sicca syndrome in nine cases, cataract formation in 10 cases, and radiation optic neuropathy in four cases.
Conclusion
Proton therapy with 20 CGE is an efficient primary therapy in choroidal hemangioma and is very effective as a secondary treatment after PDT.
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References
Witschel H, Font RL (1976) Hemangioma of the choroid; a clinicopathologic study of 71 cases and a review of literature. Surv Ophthalmol 20:425–431
Jurklies B, Anastassiou G, Ortmans S et al (2003) Photodynamic therapy using Verteporfin in circumscribed choroidal hemangioma. Br J Ophthalmol 87:84–89
Shields CL, Honavar SG, Shields JA et al (2001) Circumscribed choroidalhemangioma: clinical manifestations and factors predictive of visual outcome in 200 consecutive cases. Ophthalmology 108:2237–2248
Verbraak FD, Schlingemann RO, Keunen JE et al (2003) Longstanding symptomatic choroidal hemangioma managed with limited PDT as initial or salvage therapy. Graefes Arch ClinExpOphthalmol 241:891–898
Lanzetta P, Virgili G, Ferrari E, et al. (1995-1996) Diode laser photocoagulation of choroidal hemangioma, Int Ophthalmol;19(4):239-47
Anand R, Augsburger JJ, Shields JA (1989) Circumscribed choroidal hemangiomas. Arch Ophtalmol 107(9):1338–1342
Tsipursky MS, Golchet PR, Jampol LM (2011) Photodynamic therapy of choroidal hemangioma in Sturge-Weber syndrome, with a review of treatments for diffuse and circumscribed choroidal hemangiomas. Surv Ophthalmol 56(1):68–85
Schmidt-Erfurth U, Miller J, Sickenberg M et al (1989) Photodynamic therapy of subfoveal choroidal neovascularization: clinical and angiographic examples. Graefe’s Arch Clin Exp Ophthalmol 236(5):365–374
Jurklies B, Bornfeld N (2005) The role of photodynamic therapy in the treatment of symptomatic choroidal hemangioma. Graefes Arch Clin Exp Ophthalmol 243:393–396
Barbazetto I, Schmidt-Erfurth U (2000) Photodynamic therapy of choroidal hemangioma: two case reports. Graefes Arch Clin Exp Ophthalmol 238:214–221
Zografos L, Gailloud C, Bercher L (1989) Irradiation treatment of choroidal hemangiomas. J Fr Ophtalmol 12:797–8
Levy-Gabriel C, Rouic LL, Plancher C et al (2009) Long-term results of low-dose proton beam therapy for circumscribed choroidal hemangiomas. Retina 29(2):170–5
Denker A, Cordini D, Heufelder J et al (2007) Ion accelerator applications in medicine and cultural heritage. Nucl Inst Methods Phys Res A 580:457–461
Frau E, Rumen F, Noel G et al (2004) Low-dose proton beam therapy for circumscribed choroidal hemangiomas. Arch Ophthalmol 122(10):1471–1475
Zografos L, Egger E, Bercher L et al (1998) Proton beam irradiation of choroidal hemangiomas. Am J Ophthalmol 126:261–268
Hannouche D, Frau E, Desjardins L et al (1997) Efficacy of proton therapy in circumscribed choroidal hemangiomas associated with serous retinal detachment. Ophthalmology 104(11):1780–1784
Schilling H, Sauerwein W, Lommatzsch A et al (1997) Long term results after low dose ocular irradiation for choroidal hemangiomas. Br J Ophthalmol 81(4):267–273
Madreperla SA (2001) Choroidal hemangioma treated with photodynamic therapy using verteporfin. Arch Ophthalmol 119(11):1606–1610
Archer DB, Gardiner TA (1994) Ionizing radiation and the retina. Curr Opin Ophthalmol 5(3):59–65
Lee V, Hungerford JL (1998) Proton beam therapy for posterior pole circumscribed choroidal hemangioma. Eye 12(6):925–928
Acknowledgments
The authors would like to thank Professor Dr. Michael Foerster, M.D. Patients were treated with proton beam irradiation under his chairmanship from 2001 to 2009 in the university hospital in Charité, Berlin.
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Zeisberg A and Seibel I contributed equally to this work
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Zeisberg, A., Seibel, I., Cordini, D. et al. Long-term (4 years) results of choroidal hemangioma treated with proton beam irradiation. Graefes Arch Clin Exp Ophthalmol 252, 1165–1170 (2014). https://doi.org/10.1007/s00417-014-2635-1
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DOI: https://doi.org/10.1007/s00417-014-2635-1