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Review
. 2013 Feb;27(2):190-8.
doi: 10.1038/eye.2012.258. Epub 2012 Dec 14.

Ocular phototherapy

A D Singh  1
Affiliations
Review

Ocular phototherapy

A D Singh. Eye (Lond). 2013 Feb.

Abstract

Phototherapy can be translated to mean 'light or radiant energy-induced treatment.' Lasers have become the exclusive source of light or radiant energy for all applications of phototherapy. Depending on the wavelength, intensity, and duration of exposure, tissues can either absorb the energy (photocoagulation, thermotherapy, and photodynamic therapy (PDT)) or undergo ionization (photodisruption). For phototherapy to be effective, the energy has to be absorbed by tissues or more specifically by naturally occurring pigment (xanthophyll, haemoglobin, and melanin) within them. In tissues or tumours that lack natural pigment, dyes (verteporphin, Visudyne) with narrow absorption spectrum can be injected intravenously that act as focal absorbent of laser energy after they have preferentially localized within the tumour. Ocular phototherapy has broad applications in treatment of ocular tumours. Laser photocoagulation, thermotherapy, and PDT can be delivered with low rates of complications and with ease in the outpatient setting. Review of the current literature suggests excellent results when these treatments are applied for benign tumours, particularly for vascular tumours such as circumscribed choroidal haemangioma. For primary malignant tumours, such as choroidal melanoma, thermotherapy, and PDT do not offer local tumour control rates that are equivalent or higher than those achieved with plaque or proton radiation therapy. However, for secondary malignant tumours (choroidal metastases), thermotherapy and PDT can be applied as a palliative treatment. Greater experience is necessary to fully comprehend risks, comparative benefits, and complication of ocular phototherapy of ocular tumours.

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Figures

Figure 1
Figure 1
Absorption of visible wavelengths by three ocular pigments (melanin, haemoglobin, and xanthophyll). Modified with permission from Peyman et al.
Figure 2
Figure 2
Small RCH observed on surveillance examination in a patient with VHL disease (a). The haemangioma could be visualized with fluorescein angiography (b). Appearance immediately after laser photocoagulation (c). Four weeks later, the haemangioma is partially regressed and surrounded by a chorioretinal scar (d). Reproduced with permission from: Singh AD, Schachat AP. Treatment of retinal capillary hemangioma. In Ophthalmic Surgery: Principles and Practice 4ed. Spaeth GL, Danesh-Meyer HV, Goldberg I, Kampik A (Eds). Elsevier-Saunders: Philadelphia; 2012. pp 622–623.
Figure 3
Figure 3
Fundus appearance immediately after thermotherapy of a 1 mm retinoblastoma (a). Four weeks later, the tumour is replaced by a chorio retinal scar (b).
Figure 4
Figure 4
External recurrence following TTT. Fundus photograph showing fibrotic membrane with fine retinal neovascularization at the treated site of small choroidal melanoma following three sessions of TTT (a). B-scan ultrasonograph demonstrated a nodular extrascleral extension along the base of the original tumour (b). Photomicrograph of the posterior pole of the eye with an extensive chorioretinal scar at the site of thermotherapy. Residual deep choroidal tumour extends via a scleral canal to the extrascleral tumour nodule (c). Reproduced with permission from Singh et al.
Figure 5
Figure 5
Fundus photograph of the left eye showing an amelanotic juxtafoveal circumscribed choroidal haemangioma (a). Fluorescein angiogram (b, arterio-venous phase). Note circumscribed hyperfluorescence corresponding to the location of the choroidal haemangioma. Indocyanine green angiogram showing hypervascularity and hyperfluorescence because of choroidal haemangioma (c). B-scan ultrasonograph of a dome-shaped choroidal lesion and high internal reflectivity (thickness 2.5 mm) (d). Central visual field defects documented before PDT (e). Post-treatment fundus appearance showing regression of haemangioma (f). Post-treatment fluorescein angiogram showing absence of pre-treatment hyperfluorescence (g). Post-treatment indocyanine green angiogram demonstrating that the choroidal haemangioma is replaced by an area of hypovascular choroid (h). Post-treatment B-scan ultrasonograph showing complete flattening of the choroidal haemangioma (i). Post-treatment central visual field. Note lack of progression of pre-treatment field defects (j). Reproduced with permission from Gupta et al.
Figure 6
Figure 6
External photograph showing haemangioma distribution typical of Sturge–Weber syndrome (a). Fundus photograph showing diffuse choroidal thickening with a more prominent localized thickening in the temporal quadrant (b). B-scan ultrasonography (c). Note the dome-shaped choroidal mass that blends with the diffusely thickened choroid. Fundus photograph showing prominence of retinal pigmentation at the treatment site (d) with corresponding flattening of the choroidal haemangioma on B-scan ultrasonography (e). Note the flattening of the posterior aspect of choroidal haemangioma (between arrow heads). Reproduced with permission from Singh et al.
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