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Figure.
Pretreatment (A, C, and E) and posttreatment(B, D, and F) optic disc photographs, fluorescein angiograms, and ultrasoundscans in a patient with circumscribed choroidal hemangioma treated with palladium103 ophthalmic plaque radiotherapy. A, Pretreatment photograph showing theorange choroidal hemangioma extending beneath the fovea before brachytherapy.B, Posttreatment photograph demonstrating flattening of the tumor with residualretinal pigment epithelial mottling 29 months after treatment. C, Fluoresceinangiogram before treatment showing a coarse intratumoral vascular patternextending to the fovea. D, Pattern of residual transmission defects withinthe targeted zone. E, Pretreatment 10-MHz B-scan ultrasonogram demonstratingthe highly reflective choroidal tumor and retinal detachment. F, Most recentultrasound, obtained 25 months after treatment, showing a flattened choroidalhemangioma with complete resolution of the exudative retinal detachment. Theplus sign represents the measuring cursor for the ultrasound image; the scaleis in centimeters (larger intervals).

Pretreatment (A, C, and E) and posttreatment(B, D, and F) optic disc photographs, fluorescein angiograms, and ultrasoundscans in a patient with circumscribed choroidal hemangioma treated with palladium103 ophthalmic plaque radiotherapy. A, Pretreatment photograph showing theorange choroidal hemangioma extending beneath the fovea before brachytherapy.B, Posttreatment photograph demonstrating flattening of the tumor with residualretinal pigment epithelial mottling 29 months after treatment. C, Fluoresceinangiogram before treatment showing a coarse intratumoral vascular patternextending to the fovea. D, Pattern of residual transmission defects withinthe targeted zone. E, Pretreatment 10-MHz B-scan ultrasonogram demonstratingthe highly reflective choroidal tumor and retinal detachment. F, Most recentultrasound, obtained 25 months after treatment, showing a flattened choroidalhemangioma with complete resolution of the exudative retinal detachment. Theplus sign represents the measuring cursor for the ultrasound image; the scaleis in centimeters (larger intervals).

Table 1. 
Hemangioma Characteristics and Palladium 103 Treatment
Hemangioma Characteristics and Palladium 103 Treatment
Table 2. 
Results of Palladium 103 Treatment
Results of Palladium 103 Treatment
Table 3. 
Results of Photodynamic Therapy (PDT) for Choroidal Hemangioma
Results of Photodynamic Therapy (PDT) for Choroidal Hemangioma
Table 4. 
Comparative Results of Plaque Radiation Therapy for ChoroidalHemangioma
Comparative Results of Plaque Radiation Therapy for ChoroidalHemangioma
1.
Char  DH Posterior uveal tumors. Clinical Ocular Oncology 2nd Philadelphia,Pa Lippincott-Raven1997;89- 170
2.
Witschel  HFont  RL Hemangioma of the choroid: a clinicopathologic study of 71 cases anda review of the literature. Surv Ophthalmol 1976;20415- 431
PubMedArticle
3.
Anand  RAugsburger  JJShields  JA Circumscribed choroidal hemangiomas. Arch Ophthalmol 1989;1071338- 1342
PubMedArticle
4.
Nguyen  ATAnderson  SFTownsend  JC Circumscribed choroidal hemangioma. J Am Optom Assoc 1995;66640- 645
PubMed
5.
Sanborn  GEAugsburger  JJShields  JA Treatment of circumscribed choroidal hemangiomas. Ophthalmology 1982;891374- 1380
PubMedArticle
6.
Madreperla  SA Choroidal hemangioma treated with photodynamic therapy using verteporfin. Arch Ophthalmol 2001;1191606- 1610
PubMedArticle
7.
Schmidt-Erfurth  UMiller  JSickenberg  M  et al.  Photodynamic therapy of subfoveal choroidal neovascularization: clinicaland angiographic examples. Graefes Arch Clin Exp Ophthalmol 1998;236365- 374
PubMedArticle
8.
Schmidt-Erfurth  UMichels  SKusserow  CJurklies  BAugustin  AJ Photodynamic therapy for symptomatic choroidal hemangioma. Ophthalmology 2002;1092284- 2294
PubMedArticle
9.
Zografos  LBercher  LChamot  LGailloud  CRaimondi  SEgger  E Cobalt-60 treatment of choroidal hemangiomas. Am J Ophthalmol 1996;121190- 199
PubMed
10.
Madreperla  SAHungerford  JLPlowman  PNLaganowski  HCGregory  PT Choroidal hemangiomas. Ophthalmology 1997;1041773- 1779
PubMedArticle
11.
Finger  PTPaglione  RWPacker  S Microwave thermotherapy for choroidal hemangioma. Am J Ophthalmol 1991;111240- 241
PubMed
12.
Ritland  JSEide  NTausjo  J External beam irradiation therapy for choroidal haemangiomas. Acta Ophthalmol Scand 2001;79184- 186
PubMedArticle
13.
Hannouche  DFrau  EDesjardins  LCassoux  NHabrand  JLOffret  H Efficacy of proton therapy in circumscribed choroidal hemangiomas associatedwith serous retinal detachment. Ophthalmology 1997;1041780- 1784
PubMedArticle
14.
Kivela  TTenhunen  MJoensuu  TTommila  PJoensuu  HKouri  M Stereotactic radiotherapy of symptomatic circumscribed choroidal hemangiomas. Ophthalmology 2003;1101977- 1982
PubMedArticle
15.
Robertson  DM Photodynamic therapy for choroidal hemangioma associated with serousretinal detachment. Arch Ophthalmol 2002;1201155- 1161
PubMedArticle
16.
Porrini  GGiovannini  AAmato  GIoni  APantanetti  M Photodynamic therapy of circumscribed choroidal hemangioma. Ophthalmology 2003;110674- 680
PubMedArticle
17.
Jurklies  BAnastassiou  GOrtmans  S  et al.  Photodynamic therapy using verteporfin in circumscribed choroidal hemangioma. Br J Ophthalmol 2003;8784- 89
PubMedArticle
18.
Kjeka  OKrohn  J Photodynamic therapy of circumscribed choroidal hemangioma. Acta Ophthalmol Scand 2002;80557- 558
PubMedArticle
19.
Landau  IMSteen  BSeregard  S Photodynamic therapy for circumscribed choroidal hemangioma. Acta Ophthalmol Scand 2002;80531- 536
PubMedArticle
20.
Sheidow  TGHarbour  JW Photodynamic therapy for circumscribed choroidal hemangioma. Can J Ophthalmol 2002;37314- 317
PubMed
21.
Taylor  JM Use of sources for brachytherapy. Fed Regist 1989;5441819- 41821
22.
Finger  PTMoshfeghi  DMHo  TK Palladium-103 ophthalmic plaque radiotherapy. Arch Ophthalmol 1991;1091610- 1613
PubMedArticle
23.
Finger  PTBerson  ANg  TSzechter  A Palladium-103 plaque radiotherapy for choroidal melanoma. Int J Radiat Oncol Biol Phys 2002;541438- 1445
PubMedArticle
24.
Schilling  HSauerwein  WLommatzsch  A  et al.  Long-term results after low dose ocular irradiation for choroidal hemangiomas. Br J Ophthalmol 1997;81267- 273
PubMedArticle
25.
Stallard  HB Radiotherapy for malignant melanoma of the choroid. Br J Ophthalmol 1966;50147- 155
PubMedArticle
26.
Packer  SStoller  SLesser  MLMandel  FSFinger  PT Long-term results of iodine-125 irradiation of uveal melanoma. Ophthalmology 1992;99767- 774
PubMedArticle
27.
Sealy  RLe Roux  PLRapley  FHering  EShackleton  DSevel  D The treatment of ophthalmic tumors with low-energy sources. Br J Radiol 1976;49551- 554
PubMedArticle
28.
Finger  PTBerson  ASzechter  A Palladium-103 plaque radiotherapy for choroidal melanoma. Ophthalmology 1999;106606- 613
PubMedArticle
Clinical Sciences
November 2004

Palladium 103 (103Pd) Plaque Radiation Therapy for CircumscribedChoroidal Hemangioma With Retinal Detachment

Author Affiliations

Author Affiliations: Departments of Ophthalmology,New York Eye Cancer Center (Drs Aizman and Finger), New York Eye and Ear Infirmary(Drs Shabto and Berson), and New York University School of Medicine (Drs Aizmanand Finger), and Department of Radiation Oncology, St Vincent’s ComprehensiveCancer Center (Drs Szechter and Berson), New York.

Arch Ophthalmol. 2004;122(11):1652-1656. doi:10.1001/archopht.122.11.1652
Abstract

Objective  To describe clinical experience with palladium 103 (103Pd)ophthalmic plaque radiotherapy for choroidal hemangioma.

Methods  One course of 103Pd ophthalmic plaque radiotherapy was usedin each of 5 patients with circumscribed choroidal hemangioma who had progressiveloss of vision due to subretinal exudation. A mean apex dose of 2900 cGy (2900rad) was delivered. Functional tests of outcome included best-corrected visualacuity. Anatomic results included changes in tumor height and subretinal fluiddocumented by ophthalmoscopy, fluorescein angiography, and ultrasonography.

Results  All patients had complete resolution of subretinal fluid with reattachmentof the retina. All tumors decreased in height (mean, 50%) after treatment.Three patients (60%) demonstrated improvement in visual acuity at the lastfollow-up, and in 1 patient vision remained stable with resolution of metamorphopsia.Twenty-four months after treatment, 1 patient whose visual acuity had recoveredfrom 20/160 to 20/32 had a loss of vision to 20/160 because of radiation maculopathy.For all patients, a mean visual acuity improvement of 2 lines was documented(95% confidence interval, 0.23-0.88). Mean follow-up was 18.6 months (range,6-29 months).

Conclusions  A single 103Pd plaque radiation treatment was effective indecreasing tumor height, eliminating subretinal fluid, and improving visualacuity in patients with symptomatic circumscribed choroidal hemangiomas.

Circumscribed choroidal hemangioma is a benign vascular tumor that typicallyappears as a subtle, amelanotic, red-orange mass in the posterior pole.1 Mild yellow-white foci on the tumor surface may bepresent and represent fibrous metaplasia of the overlying retinal pigmentepithelium.2 Visual acuity loss typically resultsfrom intraretinal edema, cystoid degeneration, and accumulation of subretinalfluid. Massive exudation may lead to serous retinal detachment.3

Various treatment modalities have been described for symptomatic choroidalhemangiomas and have included penetrating diathermy, xenon photocoagulation,argon laser photocoagulation, microwave hyperthermia, external beam radiotherapy,infrareddiode laser thermotherapy, photodynamic therapy, stereotactic radiotherapy,and radioactive plaque therapy.314

Laser photocoagulation was previously widely used to treat choroidalhemangiomas. The photocoagulation was scattered over the tumor’s surfaceto reduce associated subretinal fluid.5 Becauseof recurrence of retinal detachments, multiple treatments were required andthe long-term visual prognosis was poor.35 Morerecently, various researchers have reported successful treatments of symptomaticcircumscribed choroidal hemangiomas by photodynamic therapy (PDT).68,1520

Several researchers have also reported successful treatment of diffuseand circumscribed choroidal hemangiomas with radiation therapy.9,10,12,13 In1996, Zographos et al9 investigated cobalt60 (60Co) brachytherapy and suggested that radiotherapy was the best therapeuticmodality for the treatment of large hemangiomas, those that involve the maculararea, and hemangiomas associated with a bullous secondary exudative retinaldetachment. Madreperla et al10 found that inpatients with circumscribed choroidal hemangiomas treated with iodine I 125(125I) or ruthenium 106 (106Ru) brachytherapy, 75% hadvisual acuity of 20/40 or better at 1 year, and they noted resolution of subretinalfluid in 100% of cases. Most recently, Kivela et al14 reportedtheir experience with stereotactic radiosurgery for circumscribed choroidalhemangioma. They noted resolution of subretinal fluid in all patients andsuggested that stereotactic therapy be targeted to small and posteriorly locatedcircumscribed choroidal hemangiomas.14

In 1989, palladium 103 (103Pd) seeds became available forbrachytherapy.21 Comparative studies have shownthat when equivalent target doses were prescribed, the use of 103Pdresulted in an increased dose within the targeted zone (tumor) and less radiationto most normal ocular tissues compared with 125I.22 An11-year study of 103Pd plaque radiotherapy for choroidal melanomafound better visual function outcomes compared with the results from centersusing 125I.23

Herein are reported what we believe to be the first visual and anatomicresults of a series of patients with symptomatic choroidal hemangiomas treatedwith 103Pd ophthalmic plaque radiotherapy.

METHODS
PATIENT SELECTION

A prospective, nonrandomized clinical study was conducted in 5 consecutivepatients with previously untreated and symptomatic circumscribed choroidalhemangioma. The diagnosis was made by clinical ophthalmoscopic, fluoresceinangiographic, and ultrasonographic features. Each patient participated ina detailed discussion of the risks and benefits of various therapeutic modalities.All patients signed a statement of informed consent. Institutional reviewboard approval was not considered necessary because of the established useof radiation therapy for choroidal hemangiomas.

DIAGNOSIS

Clinical history included the patient’s age, sex, and medicalhistory. Ophthalmic evaluations included a best-corrected visual acuity andpupillary, oculomotor, and slitlamp examinations. Goldmann tonometry was usedto measure intraocular pressure. The basal dimensions of the tumors were determinedby ophthalmoscopy, fluorescein angiography, transillumination, and B-scanultrasonography. A-scan ultrasonography was used to measure the height ofthe tumor and internal reflectivity. B-scan ultrasonography was typicallyused to determine tumor location and shape and evidence of retinal detachments.Fluorescein angiography and fundus photography were used to evaluate and recordpatterns of tumor circulation, focal leakage, cystoid macular edema, and radiationretinopathy.

STATISTICAL ANALYSIS

The clinical data were analyzed with regard to improvement in visualacuity after treatment. The SPSS software package, version 11.01 (SPSS Inc,Chicago, Ill), was used for data analysis. The modified Wald test was usedto calculate 95% confidence interval.

PALLADIUM 103 OPHTHALMIC PLAQUE RADIOTHERAPY

Palladium 103 seeds were available at strengths of up to 5 mCi (185MBq) per seed (model 200; Theragenics Corp, Buford, Ga). The cylindrical titanium-encapsulated 103Pd seeds measured 0.8 mm in diameter and 4.5 mm in length. Seedswere affixed into standard COMS (Collaborative Ocular Melanoma Study)–typegold plaques (Trachsel Dental Studio Inc, Rochester, Minn) with a thin layerof medical-grade acrylic fixative. Because of low energy of x-rays from 103Pd, the 0.5-mm-thick plaque blocked more than 99% of photons directedto the sides of and posterior to the plaque.22 Ourmethods of 103Pd plaque dosimetry have been described elsewhere.22,23

In this series, all patients received 1 radiation treatment. Eye plaqueswere sewn to the episclera to cover the base of the intraocular tumor, radiationwas continuously delivered during 2 to 5 days, and the plaques were removed.The tumor apex served as the radiation prescription point. Treatment timeand dose rate were calculated on the basis of the dimensions of the tumorsand followed COMS guidelines, whereby the apex dose rate was kept between50 and 125 cGy/h (50 and 125 rad/h). Similarly, a treatment margin of 2 mmwas included around the edges of the tumor. The mean apex dose for the 5 patientswho were treated with 103Pd was 2900 cGy (2900 rad) (Table 1).

RESULTS

Five patients with symptomatic circumscribed choroidal hemangiomas weretreated by 103Pd brachytherapy. The mean age in this group was55 years (range, 45-70 years). Follow-up was documented during a mean intervalof 18.6 months (range, 6-29 months). The mean height of all tumors was 3.3mm as measured by ultrasound (range, 2.5-4.0 mm) (Table 2). All tumors decreased in height (to a mean of 1.7 mm) (Figure). No tumor recurrence was noted.

All tumor-associated retinal detachments resolved within the reportedfollow-up period (Figure). Visual acuityimproved in 4 (80%) of 5 patients after treatment, and 1 patient’s visualacuity remained stable at 20/32 (with resolution of metamorphopsia). Twenty-fourmonths after treatment, 1 patient whose visual acuity had recovered from 20/160to 20/32 had a loss of vision to 20/160 because of radiation maculopathy.At the last follow-up, 3 patients (60%) retained their postoperative best-correctedvisual acuity. For all patients, a mean visual acuity improvement of 2 lineswas documented (95% confidence interval, 0.23-0.88) (Table 2). Compared with the results after other radiotherapy techniques,no new complications could be attributed to the use of 103Pd.

COMMENT

Circumscribed choroidal hemangioma is a vascular tumor that can causepermanent loss of vision by leakage ofsubretinal fluid, associated retinaldetachment, and cystoid degeneration of the retina.4 Managementbecomes more problematic with large or anteriorly located tumors, lesionsassociated with extensive bullous retinal detachment, or tumors located inproximity to the optic nerve or fovea.

Laser photocoagulation will typically reduce the exudative subretinalfluid, but recurrences are common and associated with vision loss.5 Recently, Schmidt-Erfurth et al,7,8 Madreperla,6 Robertson,15 and otherresearchers have reported on PDT in treatment of symptomatic circumscribedchoroidal hemangiomas.1620 Onaverage, 2 PDT treatments were required to control exudation of subretinalfluid. Overall, 60 patients were treated and 51 had an improvement in visualacuity (mean, 3.3 lines) after PDT (Table 3).Tumors were noted to decrease from a mean pretreatment tumor height of 3.0mm to 0.4 mm at the last follow-up measurement. It is important to note thatproblems associated with PDT for large vascular lesions have included focalovertreatment, leading to chorioretinal atrophy and resultant visual fielddefects.8 Photodynamic therapy is not practicalfor treatment of large or anteriorly located hemangiomas. Clearly, PDT relieson the visualization of the hemangioma to aim the sensitizing laser spot andto provide complete coverage of the lesion. Therefore, if a tumor is hiddenbeneath a large serous retinal detachment, treatment of the tumor by PDT becomesproblematic. In contrast, ophthalmic plaque radiation therapy is performedthroughout the sclera and therefore is not dependent on visualization of thetumor during treatment. Finally, unlike PDT, ophthalmic plaque brachytherapyrequires 2 surgical procedures.

Several investigators reported favorable anatomic and visual resultsafter external beam radiotherapy for choroidal hemangiomas (Table 4).10,12 Theysuggested that external beam radiotherapy could be a useful therapeutic optionfor symptomatic choroidal hemangiomas.24 However,when compared with plaque brachytherapy, external beam radiotherapy distributesradiation over a larger area, potentially increasing the risk of radiation-inducedkeratoconjunctivitis sicca, cataract, retinopathy, or optic neuropathy.

Recently, Kivela et al14 reported a seriesof 5 patients with symptomatic circumscribed choroidal hemangiomas treatedwith stereotactic radiotherapy. In their series, 1 patient lost 7 lines ofbest-corrected visual acuity at 26 months and 4 patients were within 2 linesat 20 months of follow-up.14 The relativelyhigh cost of stereotactic radiotherapy must be considered in the current eraof cost-effectiveness.

In 1966, Stallard25 introduced the firstradioactive ophthalmic plaques (60Co). Packer et al26 andSealy et al27 noted that when compared with60Co,the much lower-energy photons (28 keV) emitted from 125I plaqueswere more rapidly absorbed in tissue and, therefore (for equivalent apex dose),reached fewer normal ocular structures. In this series, 103Pd offeredeven lower-energy photons than 125I and greater tissue penetrationthan106Ru.28 Therefore, a switch from 125I to 103Pd seeds increased irradiation of the tumor, whilesimultaneously decreasing the amount of radiation to most normal ocular structuresoutside the targeted zone.22,23,28 Inaddition, an 11-year study of 103Pd plaque radiotherapy for choroidalmelanoma showed better visual results than those from centers using 125I.23 This is why we chose to use 103Pd for this study of plaque radiation for medium-sized choroidalhemangiomas. If we were to treat larger hemangiomas (ie, >8 mm in height),we would choose the radiation treatment modality on the basis of comparativedosimetry.23 We expect that patterns of secondaryradiation complications can be predicted by dosimetry studies, but proofsof these differences will require a large comparative clinical trial.

This study describes the first (to our knowledge) clinical experiencewith 103Pd ophthalmic plaque radiotherapy for symptomatic choroidalhemangioma. Anatomic and functional outcomes were documented for up to 29months (mean, 18.6 months) of follow-up. Limitations of this study includethe small number of patients and a relatively short follow-up. With longer-termfollow-up, it is possible that radiation maculopathy may affect the visualacuity of patients irradiated for posterior uveal tumors (as seen in 1 patientin this study).

In this series, the mean best-corrected Early Treatment Diabetic RetinopathyStudy visual acuity at the last follow-up improved by 2 lines. All patientshad complete resolution of subretinal fluid with reattachment of the retinaafter a single treatment. All tumors decreased in height, with a mean decreaseof 50% (from 3.3 to 1.7 mm after treatment).

This pilot study shows that a single 103Pd ophthalmic plaqueradiation treatment is effective in eliminating subretinal fluid and improvingvision in patients with symptomatic circumscribed choroidal hemangiomas.

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Article Information

Correspondence: Paul T. Finger, MD, NewYork Eye Cancer Center, 115 E 61st St, New York, NY 10021 (pfinger@eyecancer.com).

Financial Disclosure: None.

Submitted for Publication: July 31, 2003; finalrevision received March 9, 2004; accepted April 21, 2004.

Funding/Support: This work was supported byThe EyeCare Foundation and Research to Prevent Blindness, both in New York,NY.

References
1.
Char  DH Posterior uveal tumors. Clinical Ocular Oncology 2nd Philadelphia,Pa Lippincott-Raven1997;89- 170
2.
Witschel  HFont  RL Hemangioma of the choroid: a clinicopathologic study of 71 cases anda review of the literature. Surv Ophthalmol 1976;20415- 431
PubMedArticle
3.
Anand  RAugsburger  JJShields  JA Circumscribed choroidal hemangiomas. Arch Ophthalmol 1989;1071338- 1342
PubMedArticle
4.
Nguyen  ATAnderson  SFTownsend  JC Circumscribed choroidal hemangioma. J Am Optom Assoc 1995;66640- 645
PubMed
5.
Sanborn  GEAugsburger  JJShields  JA Treatment of circumscribed choroidal hemangiomas. Ophthalmology 1982;891374- 1380
PubMedArticle
6.
Madreperla  SA Choroidal hemangioma treated with photodynamic therapy using verteporfin. Arch Ophthalmol 2001;1191606- 1610
PubMedArticle
7.
Schmidt-Erfurth  UMiller  JSickenberg  M  et al.  Photodynamic therapy of subfoveal choroidal neovascularization: clinicaland angiographic examples. Graefes Arch Clin Exp Ophthalmol 1998;236365- 374
PubMedArticle
8.
Schmidt-Erfurth  UMichels  SKusserow  CJurklies  BAugustin  AJ Photodynamic therapy for symptomatic choroidal hemangioma. Ophthalmology 2002;1092284- 2294
PubMedArticle
9.
Zografos  LBercher  LChamot  LGailloud  CRaimondi  SEgger  E Cobalt-60 treatment of choroidal hemangiomas. Am J Ophthalmol 1996;121190- 199
PubMed
10.
Madreperla  SAHungerford  JLPlowman  PNLaganowski  HCGregory  PT Choroidal hemangiomas. Ophthalmology 1997;1041773- 1779
PubMedArticle
11.
Finger  PTPaglione  RWPacker  S Microwave thermotherapy for choroidal hemangioma. Am J Ophthalmol 1991;111240- 241
PubMed
12.
Ritland  JSEide  NTausjo  J External beam irradiation therapy for choroidal haemangiomas. Acta Ophthalmol Scand 2001;79184- 186
PubMedArticle
13.
Hannouche  DFrau  EDesjardins  LCassoux  NHabrand  JLOffret  H Efficacy of proton therapy in circumscribed choroidal hemangiomas associatedwith serous retinal detachment. Ophthalmology 1997;1041780- 1784
PubMedArticle
14.
Kivela  TTenhunen  MJoensuu  TTommila  PJoensuu  HKouri  M Stereotactic radiotherapy of symptomatic circumscribed choroidal hemangiomas. Ophthalmology 2003;1101977- 1982
PubMedArticle
15.
Robertson  DM Photodynamic therapy for choroidal hemangioma associated with serousretinal detachment. Arch Ophthalmol 2002;1201155- 1161
PubMedArticle
16.
Porrini  GGiovannini  AAmato  GIoni  APantanetti  M Photodynamic therapy of circumscribed choroidal hemangioma. Ophthalmology 2003;110674- 680
PubMedArticle
17.
Jurklies  BAnastassiou  GOrtmans  S  et al.  Photodynamic therapy using verteporfin in circumscribed choroidal hemangioma. Br J Ophthalmol 2003;8784- 89
PubMedArticle
18.
Kjeka  OKrohn  J Photodynamic therapy of circumscribed choroidal hemangioma. Acta Ophthalmol Scand 2002;80557- 558
PubMedArticle
19.
Landau  IMSteen  BSeregard  S Photodynamic therapy for circumscribed choroidal hemangioma. Acta Ophthalmol Scand 2002;80531- 536
PubMedArticle
20.
Sheidow  TGHarbour  JW Photodynamic therapy for circumscribed choroidal hemangioma. Can J Ophthalmol 2002;37314- 317
PubMed
21.
Taylor  JM Use of sources for brachytherapy. Fed Regist 1989;5441819- 41821
22.
Finger  PTMoshfeghi  DMHo  TK Palladium-103 ophthalmic plaque radiotherapy. Arch Ophthalmol 1991;1091610- 1613
PubMedArticle
23.
Finger  PTBerson  ANg  TSzechter  A Palladium-103 plaque radiotherapy for choroidal melanoma. Int J Radiat Oncol Biol Phys 2002;541438- 1445
PubMedArticle
24.
Schilling  HSauerwein  WLommatzsch  A  et al.  Long-term results after low dose ocular irradiation for choroidal hemangiomas. Br J Ophthalmol 1997;81267- 273
PubMedArticle
25.
Stallard  HB Radiotherapy for malignant melanoma of the choroid. Br J Ophthalmol 1966;50147- 155
PubMedArticle
26.
Packer  SStoller  SLesser  MLMandel  FSFinger  PT Long-term results of iodine-125 irradiation of uveal melanoma. Ophthalmology 1992;99767- 774
PubMedArticle
27.
Sealy  RLe Roux  PLRapley  FHering  EShackleton  DSevel  D The treatment of ophthalmic tumors with low-energy sources. Br J Radiol 1976;49551- 554
PubMedArticle
28.
Finger  PTBerson  ASzechter  A Palladium-103 plaque radiotherapy for choroidal melanoma. Ophthalmology 1999;106606- 613
PubMedArticle
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