Case Series of Anti-Vascular Endothelial Growth Factor and Photodynamic Therapy in the Treatment of Circumscribed Choroidal Hemangiomas

Purpose: To describe circumscribed choroidal hemangioma (CCH) management in the era of intravitreal anti-vascular endothelial growth factor. Methods: Retrospective chart review of 11 patients (4 men and 7 women; mean age: 47 years) who were treated at University of Wisconsin for CCH between January 1, 2009 and June 1, 2015, using photodynamic therapy (PDT), intravitreal bevacizumab, or a combination of both PDT and bevacizumab. We define change in visual acuity with each treatment as change in Snellen visual acuity from the day of treatment compared to the follow-up appointment closest to the 3-month posttreatment time point. We report visual acuity score (VAS) by converting Snellen visual acuity using the formula, VAS = 100 − 50 × logarithm of the minimum angle of resolution. Results: We treated 7 eyes with PDT only, 1 eye with bevacizumab only, and 4 eyes with combined PDT and bevacizumab. In the PDT-only group, visual acuity improved in 4 eyes, stabilized in 2 eyes, and worsened in 1 eye (average +7.8 letters by VAS). In the 1 eye treated with bevacizumab alone, visual acuity improved by 2.6 letters by VAS. In the combined group, visual acuity improved in 3 eyes and stabilized in 1 eye (average +6.2 letters by VAS). Conclusion: Our study supports the effectiveness and safety of PDT as a primary treatment modality. In addition, our study suggests the independent efficacy of bevacizumab monotherapy in select patients, the synergistic response to bevacizumab with repeated PDT, and potentially reduction of PDT treatments by adding bevacizumab to the treatment protocol.