A fast protocol for photodynamic therapy in exudative choroidal circumscribed hemangioma: Early laser irradiance after end of verteporfin infusion

PURPOSE: The aim of the study is to compare the risk of first-line photodynamic therapy (PDT) failure according to the PDT protocol performed in patients with exudative choroidal circumscribed hemangioma (CCH).

METHODS: We retrospectively included patients from 11 European centres in France, Italy and Denmark. Two groups were established: patients treated with Standard Protocol PDT (SP-PDT) and patients treated with a 'Fast' Protocol PDT (FP-PDT), characterised by laser irradiation without delay after the end of the verteporfin infusion (8 min after start of infusion). We analysed groups on the risk of exudative CCH recurrence requiring a second line of treatment, defining the first-line PDT failure.

RESULTS: A total of 111 patients were included in the study: 76 treated with the SP-PDT and 35 with the FP-PDT. First-line PDT failure was observed for 45 patients (59%) in the SP-PDT group and 9 patients (26%) in the FP-PDT group, with a median follow-up of 3.5 [1.7-6.7] years and 2.3 [0.8-3.9] years, respectively. Final best-corrected visual acuity (BCVA) improvement did not differ between groups (p = 0.49). A multivariate survival analysis including initial CCH thickness and initial BCVA was performed over a two-year follow-up period: FP-PDT as first-line treatment was significantly associated with a lower risk of PDT failure [HR = 0.27, 95%CI (0.11-0.65)].

CONCLUSION: FP-PDT shows encouraging results in the treatment of CCHs, as it is associated with a lower risk of PDT failure. It may therefore represent an interesting avenue for optimised PDT parameters, although these results need to be confirmed by randomised trials.