Multifocal photodynamic therapy for diffuse choroidal hemangioma

Marcus Ang, Shu-Yen Lee

Singapore Eye Research Institute, Singapore National Eye Centre, Singapore

Background: A choroidal hemangioma is an uncommon benign vascular tumor of the choroid that can be either circumscribed or diffuse. In our experience, diffuse choroidal hemangiomas in Asian patients often require multiple photodynamic therapy (PDT) treatment sessions.
Methods: We here provide a case report of a 7-year-old boy with Sturge–Weber syndrome who presented with diffuse choroidal hemangioma in the left eye. Five sessions of PDT treatment were required over a period of 1 year and a final optical coherence tomogram 3 months later revealed resolution of subretinal fluid and the choroidal hemangioma.
Results: Final visual acuity was 20/100 in the left eye with resolution of subretinal fluid. This case report illustrates that a single application of PDT using standard published parameters was insufficient to achieve the destruction of the enlarged vessels. This experience is similar to previous Chinese reports on circumscribed choroidal hemangiomas. The decision for repeat treatment was based on subretinal fluid recurrence, rather than complete tumor regression.
Conclusion: Our case report supports previous suggestions that larger dilated vessels in the vascular network of a choroidal hemangioma might affect the efficacy and selectivity of PDT in treating the eyes of Asian patients – which may explain the need for multiple treatments.

Keywords: choroidal hemangioma, Sturge–Weber syndrome, optical coherence tomography