Focal laser photocoagulation for circumscribed choroidal hemangioma: a case report

Circumscribed choroidal hemangioma (CCH) is a benign vascular tumor that may cause visual loss due to chronic subretinal fluid and macular involvement. Various treatment modalities have been described, including photodynamic therapy, laser photocoagulation, and anti-vascular endothelial growth factor (VEGF) therapy. We report a case of symptomatic CCH successfully treated with focal laser photocoagulation after an inadequate response to intravitreal aflibercept.

A 59-year-old male presented with progressive visual decline in the left eye. Clinical examination and multimodal imaging, including fundus photography, optical coherence tomography (OCT), and fluorescein angiography (FA), were performed. The patient initially received three monthly intravitreal aflibercept injections without significant anatomical or functional improvement. Focal laser photocoagulation was subsequently applied directly over the extrafoveal lesion.

Fundus examination revealed an orange choroidal lesion nasal to the optic disc, with associated subretinal fluid extending to the macula. OCT demonstrated subretinal and intraretinal fluid, while FA showed progressive hyperfluorescence consistent with CCH. Following two sessions of focal laser photocoagulation, complete resolution of subretinal fluid was achieved. Best-corrected visual acuity improved from 6/120 to 6/15 and remained stable throughout 18 months of follow-up without recurrence.

Focal laser photocoagulation can provide favorable anatomical and visual outcomes in selected patients with extrafoveal CCH, particularly when anti-VEGF therapy is ineffective and photodynamic therapy is unavailable.