Photodynamic therapy for choroidal hemangioma unresponsive to ranibizumab

To report a patient with circumscribed choroidal hemangioma with serous macular detachment successfully treated with photodynamic therapy (PDT) after being unresponsive to treatment with intravitreal ranibizumab.

A 63-year-old Asian woman was incidentally found to have a circumscribed choroidal hemangioma without symptoms in the left eye during a routine health examination. Blurred vision of the left eye developed 3.5 years later, and a serous macular detachment was observed. Two consecutive intravitreal ranibizumab injections were administered, but the subretinal fluid (SRF) persisted and the vision did not improve. One PDT session was then given, and the SRF resolved completely within 1 month. The best-corrected visual acuity improved from 20/50 before treatment to 20/25 at 4 months after the PDT. The tumor thickness also decreased from 3.84 mm before treatment to 2.86 mm at 14 months after PDT.

Circumscribed choroidal hemangioma with serous macular detachment may not respond to anti-vascular endothelial growth factor agents. Photodynamic therapy may be an effective choice in such cases to remove SRF and improve vision.