Circumscribed Choroidal Hemangioma Comparison of Outcomes by Treatment with Laser Photocoagulation or Transpupillary Thermotherapy

Purpose: To compare the visual and anatomical results of cases of circumscribed choroidal hemangiomas after treated by laser photocoagulation or transpupillary thermotherapy (TTT). Method: A retrospective review was performed on patients with circumscribed choroidal hemangiomas treated by photocoagulation or TTT between January 1995 and June 2004. Patients' age, gender, length of follow-up, visual symptoms, visual acuity at presentation and follow-up, tumor location, and the status of subretinal fluid were recorded. Stationary visual acuity was defined as changes of visual acuity within two lines on the Snellen chart before and after the treatment. Poor vision was defined as visual acuity less than 0.1. Results: Fourteen eyes of 14 patients with symptomatic circumscribed choroidal hemangioma were included. The average age was 43 years old and they were followed for a mean of 15.4 months. Seven of the 14 patients had foveal involvement of the tumor or associated subretinal fluid. Seven patients received photocoagulation and 7 received TTT as the primary treatment. Of the 7 patients treated by laser photocoagulation, two (28%) had post treatment visual acuity better than that at presentation. None improved more than two Snellen lines of visual acuity. Complete resolution of subretinal fluid was noted in five patients (71%). Of the 7 patients treated by TTT, three (42%) had post treatment visual acuity better than that at presentation. None improved more than 2 lines of visual acuity. Five patients (71%) showed complete resolution of subretinal fluid. All of the 14 patients preserved a stationary visual acuity (within two Snellens' line). Seven of the 14 patients had final visual acuity less than 0.1. Conclusion: Photocoagulation and TTT showed similar effect on visual pro-gnosis and subretinal fluid resolution in our case series. Poor post treatment visual acuity was related with tumor or subretinal fluid involving the fovea and poor initial visual acuity. Fifty percent of patients had visual acuity less than 0.1 though the rate of complete subretinal fluid absorption was as high as 71%.