High-dose iodine-125 episcleral brachytherapy for circumscribed choroidal haemangioma

To evaluate episcleral plaque radiotherapy with high-dose (125)I for the treatment of circumscribed choroidal haemangioma (CCH).

A retrospective review was performed of patients treated for CCH between 1995 and 2007. Brachytherapy was performed with ROPES plaques loaded with (125)I seeds with a target apex dose of 48 Gy. Main outcome measures were regression of CCH, resolution of retinal detachment, visual acuity changes and frequency of radiation-related complications.

Eight patients met the inclusion criteria. Mean tumour base was 11.3 (range 7.8-14.3) mm and mean height was 4.4 (range 2.8-6.5) mm. Six patients had an associated retinal detachment and seven macular exudates or oedema. Mean preoperative visual acuity ranged from no light perception to 0.7. Three patients had received prior argon laser treatment. All patients received one radiation treatment, since no new symptoms due to CCH developed during follow-up (mean 83 (range 23-123) months). Tumour regression was found in all cases. Three patients presented radiation retinopathy and one subretinal fibrosis. Visual acuity remained stable in six patients and decreased two or more lines in two patients.

Episcleral brachytherapy led to tumour regression and resolution of non-rhegmatogenous secondary retinal detachments in this case series that included large CCH. Visual stabilisation was achieved in most cases. Given the acceptable rate of side effects detected, (125)I episcleral brachytherapy should be considered in large tumours, in tumours with a subfoveal location or extensive subretinal fluid, and in tumours that have failed to respond to other treatments.