Korean J Ophthalmol.  2009 Jun;23(2):127-131. 10.3341/kjo.2009.23.2.127.

Application of Intravitreal Bevacizumab for Circumscribed Choroidal Hemangioma

• Sagong M
• Lee J
• Chang W

• KMID: 754733
• DOI: http://doi.org/10.3341/kjo.2009.23.2.127

Abstract

We report 3 cases of circumscribed choroidal hemangioma (CCH) effectively managed with intravitreal bevacizumab. One patient (case 1) who had recurrent CCH (1.6 mm in thickness) with prior laser photocoagulation was treated with intravitreal bevacizumab alone. Two patients (case 2 and 3) who had CCH (2.4 mm and 2.2 mm in thickness, respectively) with recent visual impairment were treated with bevacizumab followed by photodynamic therapy (PDT). Ophthalmic evaluations included visual acuity, ophthalmoscopic examination, fluorescein angiography, ultrasonography, and optical coherence tomography. Patients were followed up for 6-9 months. After therapy, all patients showed improved visual acuity due to complete resorption of subretinal fluid and macular edema. Ultrasonography demonstrated a reduction of the thickness of CCH in case 1 and complete regression of the lesions in case 2 and 3. No patient showed tumor recurrence. Intravitreal bevacizumab, alone or in combination therapy with PDT, may be a useful alternative for the treatment of symptomatic CCH with subretinal fluid.

Keyword

Bevacizumab; Choroidal hemangioma; Photodynamic therapy

MeSH Terms

Angiogenesis Inhibitors/*administration & dosage
Antibodies, Monoclonal/*administration & dosage
Choroid Neoplasms/diagnosis/*drug therapy
Diagnosis, Differential
Female
Follow-Up Studies
Hemangioma/diagnosis/*drug therapy
Humans
Injections
Male
Middle Aged
Ophthalmoscopy
Tomography, Optical Coherence
Vascular Endothelial Growth Factor A
Vitreous Body

Figure

• 

  Fig. 1 Case 1. (A) Recurrent choroidal hemangioma with submacular fluid, previously treated by photocoagulation, before intravitreal bevacizumab. Ultrasonography reveals a tumor thickness of 1.6 mm. Optical coherence tomography (OCT) demonstrates the presence of submacular fluid. (B) Two months after intravitreal bevacizumab. The hemangioma thickness is reduced on ultrasonography and the subretinal fluid around the tumor is absorbed on OCT.

• 

  Fig. 2 Case 2. (A) A red-orange choroidal hemangioma with submacular fluid. Fluorescein angiography shows late patchy staining of the tumor with some dye leakage into the submacular space and ultrasonography reveals a solid dome-shaped lesion 2.4 mm in thickness. (B) Three months after bevacizumab followed by photodynamic therapy. The hemangioma has flattened and shows pigmentary change by the retinal pigment epithelium atrophy. Fluorescein angiography reveals marked regression of the leakage into the macula and some hypofluorescence caused by pigmentary change. The tumor has regressed to a non-measurable thickness on ultrasonography.

• 

  Fig. 3 Case 3. (A) A red-orange choroidal hemangioma contiguous with optic nerve from the 8-o'clock position clockwise to the 1-o'clock position. A serous detachment around the tumor extends into the macula. Fluorescein angiography shows dye leakage into the submacular space and optical coherence tomography (OCT) demonstrates serous detachment around the fovea. (B) Three months after bevacizumab followed by photodynamic therapy. The tumor has flattened around the macula, without subretinal fluid. Fluorescein angiography shows no submacular leakage and diminished hyperfluorescence in the tumor. OCT shows nearly regular foveal anatomy.

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