Blackening of a choroidal hemangioma after photodynamic therapy.
BACKGROUND
Photodynamic therapy has recently advanced to a first line treatment of symptomatic circumscribed choroidal hemangiomas.


METHODS
A sixty-year-old male patient was referred with progressive visual loss in his left eye. Visual acuity measured 20/80 and fundus examination revealed a prominent red subretinal lesion superior to the fovea with adjacent pigment epithelial irregularities. Thickening of the central retina was seen on OCT imaging. Sonography revealed a dome-shaped lesion with a maximal thickness of 3.3 mm and high internal reflectivity. Combined fundus indocyanine green and fluorescein angiography showed early filling of large vessels within the tumor.


RESULTS
The hemangioma was treated with verteporphin photodynamic therapy. Two days after treatment, with vision unchanged, fundus examination revealed blackening of the tumor. Two months later vision increased to 20/40 and the tumor area was atrophic and bright red with a slight hyperpigmented rim. Angiography revealed the disappearance of tumor vessels and choroidal hypoperfusion in the area of treatment.


CONCLUSIONS
Choroidal hemangiomas may darken initially after photodynamic therapy. This is most probably caused by large coaguli within the voluminous lacuna-like blood-filled vessel system of the hemangioma that are induced by photothrombosis.
Bosch
M M
MM
Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland. martina.boesch@usz.ch
Helbig
H
H
D001284:Atrophy; D002829:Choroid / Q000473:pathology*; D002830:Choroid Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006391:Hemangioma / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D006414:Hematoporphyrin Photoradiation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D010859:Pigmentation Disorders / Q000209:etiology*