Diffuse choroidal hemangioma: Ophthalmic outcomes following intensity-modulated radiation therapy.

Purpose: To report outcomes in patients treated with low-dose lens-sparing intensity-modulated radiation therapy (IMRT) for diffuse choroidal hemangioma (DCH) associated subretinal (subfoveal) fluid (SRF).

Material and methods: Retrospective interventional case series. 10 patients (11 eyes) treated with IMRT for diffuse choroidal hemangioma-associated SRF. Resolution of subretinal fluid, tumor regression, and best-corrected visual acuity (BCVA).

Results: The mean age was 9.9 years (range, 0.3-32), with 8 (73%) having exudative retinal detachment in the right eye. The rationale for treatment was the presence of SRF (11 eyes, 100%). At baseline, the maximal height of the tumor was 3.4 mm (range, 1.7-5.3). The mean BCVA in the affected eye was 40 ETDRS letters (range, 5-75). All eyes were treated with IMRT (lens-sparing) at a dose of 20 Gy in 10 fractions. Patients were followed up for an average duration of 7 years (range 6-120 months), with 9 (82%) followed up for more than 2 years. Resolution of SRF was noted in all 11 (100%) eyes, with 6 (55%) eyes showing resolution within 3 months. Tumor response was observed in all eyes 11 (100%) (reduction or stabilization of tumor height), with the mean posttreatment height of 2.0 mm. BCVA improved or remained stable in 10 (91%). Radiation-related complications (cataracts, radiation retinopathy, radiation optic neuropathy) were not observed in any of the treated patients.

Conclusions: Low-dose lens-sparing IMRT is a highly effective treatment for diffuse choroidal hemangioma. IMRT resolves subretinal fluid, induces tumor regression, and preserves visual acuity in vast majority of cases.