Health Problem: Choroidal hemangioma is a relatively uncommon benign vascular tumor that presents either as a circumscribed mass, generally without systemic associations, or as a diffuse mass that is often associated with Sturge-Weber syndrome. Choroidal hemangiomas can produce visual acuity loss from macular fluid or even lead to serous retinal detachment and elevated risk for neovascular glaucoma, necessitating enucleation.
Technology Description: Photodynamic therapy (PDT) is a therapeutic technique that involves the use of a photosensitizing agent, such as verteporfin, that produces selective tissue damage when activated by light of a specific wavelength. Unlike other currently available treatments for choroidal hemangioma, PDT enables selective targeting of the tumor vessels with minimal damage to the overlying neurosensory retina. The primary goal of treatment with PDT is elimination of exudation and tumor control, which is thought to help restore or stabilize vision loss.
Controversy: Timing of management of choroidal hemangioma has become a controversial topic. Traditionally, treatment is withheld until it causes vision loss. However, some studies suggest that a long observation after initial diagnosis may lead to permanent visual loss. Authors of these studies advocate for modifying current thinking about the length of observation in the treatment of choroidal hemangioma. Verteporfin and PDT are used off-label for circumscribed choroidal hemangioma, and optimal treatment protocols (including dosage and timing of verteporfin, light doses, etc.) are not clearly established.
Key Questions:
- Is PDT with verteporfin effective in treating adults with choroidal hemangioma?
- How does PDT with verteporfin compare with other treatments for choroidal hemangioma?
- Is PDT with verteporfin safe?
- Have definitive patient selection criteria been identified for PDT with verteporfin?
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