Primary photodynamic therapy with verteporfin for small pigmented posterior pole choroidal melanoma.

PurposeThe purpose of the study was to investigate the outcomes of primary photodynamic therapy (PDT) for small pigmented posterior pole choroidal melanoma.Patients and methodsProspective interventional consecutive case series of 15 patients with small pigmented posterior pole choroidal melanoma, who were treated with three sessions of PDT and followed-up thereafter. Risk factors for failure were assessed and outcome measures at presentation were compared to those at last follow-up visit.ResultsTumor control was achieved in 12 (80%) patients in a median follow-up time of 15 months (mean 14, range 8-18). Three patients failed treatment, diagnosed in a median time of 5 months (mean 4, range 3-6), after first PDT. In all failed cases, lesions were 100% pigmented; de novo melanoma rather than transformed nevi and showed a radial growth pattern rather than increased thickness. All failed cases were subsequently successfully treated with radiotherapy. In this cohort, subretinal fluid (SRF) was significantly reduced (P<0.001), vision did not deteriorate (P=0.11) and even improved in patients with subfoveal SRF at presentation (P=0.018), tumor height significantly decreased (P=0.037) and no complications were recorded.ConclusionPrimary PDT was found to be a safe and efficient treatment modality for small pigmented posterior pole choroidal melanoma, achieving short-term tumor control in 80% of patients. PDT offers patients the opportunity to preserve vision by avoiding the retinopathy associated with conventional radiation treatments for choroidal melanoma. However, the long-term local control of these tumors remains uncertain.

Intravitreal bevacizumab monotherapy for choroidal neovascularisation secondary to choroidal osteoma.

PurposeThe purpose of this study is to present the outcomes of a series of patients with choroidal neovascular membrane (choroidal neovascularisation (CNV)) secondary to a choroidal osteoma undergoing anti-VEGF monotherapy.Patients and methodsRetrospective series of patients with choroidal neovascularization secondary to choroidal osteoma. All patients underwent clinical and imaging assessment (fundus photo, B-scan ultrasonography, fluorescein angiography, and optical coherence tomography-where available), and were managed with intravitreal anti-VEGF injections (Bevacizumab). Visual acuity and central retinal thickness were recorded pre treatment and at the end of the follow-up period.ResultsEight patients were included in this study. Of this, 6/8 had predominantly classic or classic and 2/8 patients had minimally classic or occult CNV. Each patient received 3-10 injections of bevacizumab. Median follow-up was 9 months (3-15 months). Visual acuity improved in 5 patients, by 2-6 Snellen lines. CNV completely regressed in 5 cases and partially regressed in 3 cases. Mean CRT reduction was 122 µm (6 to -230 µm).ConclusionIntravitreal bevacizumab can be an effective treatment modality in the management of vision threatening CNV secondary to choroidal osteoma.

Choroidal metastasis from follicular cell thyroid carcinoma masquerading as circumscribed choroidal haemangioma.

Choroidal metastases from follicular thyroid carcinoma are uncommon and usually present as an amelanotic lesion against a background of known systemic disease. We present the case of a 56-year-old woman with a thyroid metastatic focus with unusual clinical presentation, systemic involvement, and early response to systemic treatment. A review of the literature accompanies this case presentation.

Photodynamic therapy for retinal capillary hemangioma.

PURPOSE: To describe the results of photodynamic therapy (PDT) for juxtapapillary and peripheral retinal capillary hemangioma (RCH). PATIENTS AND METHODS: Interventional case series of four eyes (four patients) with juxtapapillary RCH and one eye (one patient) with peripheral RCH. Two eyes with juxtapapillary RCH had received two sessions of full-fluence, double-duration PDT; whereas other two eyes had received single session of half-fluence, single-duration PDT. The peripheral RCH was treated with a single session of full-fluence, single-duration PDT. RESULTS: Two patients had von Hippel-Lindau disease. Follow-up duration ranged from 4 months to 1 year. Pre-PDT visual acuity (VA) ranged from 20/200 to HM (juxtapapillary RCH) and 20/100 (peripheral RCH). Among the eyes with juxtapapillary RCH, tumor regression with partial resolution of macular edema was noted in two eyes (one eye each with half-fluence and full-fluence PDT), whereas two eyes had no change in tumor size with persistent macular edema. VA remained stable in three eyes and declined in one eye. In an eye with peripheral RCH, regression of tumor and macular edema with VA improvement was noted. Post-PDT complications included epiretinal membrane (one eye) and transient exudative retinal detachment (one eye). CONCLUSION: PDT can be effective in reducing macular edema associated with RCH but this does not always correspond with an improvement in VA especially for juxtapapillary tumors.

Ranibizumab monotherapy for sub-foveal haemorrhage secondary to choroidal neovascularisation in age-related macular degeneration.

PURPOSE: In a retrospective review, the functional effects of intra-vitreal ranibizumab monotherapy in patients with sub-foveal haemorrhage secondary to choroidal neovascularisation (CNV) in age-related macular degeneration (ARMD) are reported. PATIENTS AND METHODS: Twelve eyes of 12 patients were treated with intra-vitreal ranibizumab (0.5 mg in 0.05 ml) in accordance with current practice. Follow-up was arranged at monthly intervals. Eleven patients completed 6 months and seven completed 12 months of follow-up. Duration of haemorrhage, lesion size, ETDRS letter score at baseline, and follow-up were analysed. RESULTS: The mean time for complete clearance of sub-retinal haemorrhage was 4.7 months (range 3-7 months). After 6 months, visual acuity was stable or improved in 7 of 11 eyes and the mean change in ETDRS letter score was +7.6 letters (P>0.05). After 12 months, visual acuity was stable or improved in five of seven eyes and the mean change in ETDRS letter score was +7.3 letters (P>0.05). For the seven cases with 12 months of follow-up, a mean of six injections were given. Two patients had a decrease in acuity of >15 ETDRS letters during follow-up. No other local or systemic side-effects were reported. CONCLUSIONS: Intra-vitreal ranibizumab monotherapy may be an effective treatment for sub-foveal haemorrhage secondary to CNV in ARMD.