5-Year Following Up of the Treatment Effects of Plaque Brachytherapy for Circumscribed Choroidal Haemangioma in Pediatric Patients.

Abstract

Purpose: To compare the long-term clinical outcomes and anatomical regression kinetics of pediatric versus adult patients with circumscribed choroidal hemangioma (CCH) following I-125 plaque brachytherapy.

Design: Retrospective clinical cohort study.

Methods: This retrospective study included pediatric patients and adult controls diagnosed with symptomatic CCH and treated with I-125 plaque brachytherapy. Clinical and imaging data, including best-corrected visual acuity (BCVA), tumor height, and largest basal diameter (LBD), were analyzed at baseline and at 1, 6 months, 1, 2, and 5 years post-treatment. The primary outcome was the rate of tumor height reduction, and secondary outcomes included subretinal fluid (SRF) resolution and functional visual recovery.

Results: A total of 50 eyes from pediatric patients and 97 eyes from adults patients were evaluated. At baseline, the pediatric group exhibited significantly greater mean tumor height (6.45 ± 1.87mm) compared to the adult group (4.46 ± 1.46 mm, P < 0.05). Following brachytherapy, the pediatric cohort demonstrated significantly faster anatomical regression, with higher height reduction rates at 1, 6, 12, and 24 months (P < 0.01). By the 5-year following up, the cumulative height reduction was comparable between the two groups. In both cohorts, anatomical regression was characterized by more significant vertical collapse than changes in LBD. Most SRF resolved after 3 months of the surgery, while only 3 SRF cases did not resolve among pediatric patients after brachytherapy. Functional outcomes were favorable, with over 60% of patients achieving a visual improvement of >2 Snellen lines. Although children regressed faster anatomically, the final BCVA at 5 years showed no significant difference between the age groups (P > 0.05).

Conclusions: Pediatric CCH demonstrated a more rapid anatomical response to I-125 plaque brachytherapy than adult, although the greater absolute tumor regression in pediatric patients should be interpreted in the context of greater baseline tumor thickness and enhanced radiosensitivity. Despite differences in the timing and magnitude of regression, plaque brachytherapy provided substantial tumor control and visual benefits in both pediatric and adult patients. Timely intervention of brachytherapy in pediatric cases may facilitate resolution of exudation and help preserve visual function.