| 본문 : Purpose: To report a case of subfoveal capillary hemangioma managed by photodynamic therapy and intravitreal bevacizumab injection.
Case summary: A 67-year-old man had been experiencing decreased visual acuity in his right eye for 3 month. At the initial visit, corrected visual acuity of the right eye was 0.4 and that of the left eye was 0.9. Funduscopic examination showed parafoveal retinal hemorrhage with subfoveal hemangioma with branching vessel passing through it’s site of the right eye. Fluorescein angiography, indocyanine green angiography, and optical coherence tomography(OCT) were performed on both eyes. Foveal capillary rupture and leakage with hyperfluorescence, delayed arteriovenous (A-V) crossing in the superiotemporal area, and foveal capillary hemangioma with collateral vessel in the right eye were found. OCT showed macular cyst around foveal hemangioma with subretinal fluid in right eye. Intravitreal bevacizumab injection was performed. About a month later, subretinal fluid in the right eye was increased and visual acuity was deteriorated to 0.3. So photodynamic therapy was done on right eye. Over a 3-month follow up, the macular edema was persisted but subretinal fluid was decreased. Patient also said the metamorphopia had decreased. Intravitreal bevacizumab injection was administered. This improved the corrected visual acuity to 0.6 after 3months. Macular edema and subretinal fluid on OCT also improved.
Conclusions: Solitary retinal capillary hemangioma is associated with Von Hippel-Lindau (VHL) syndrome in 46% of the cases. According to reports, retinal capillary hemangioma occurs around the peripheral retina or optic nerve head, regardless of the presence of VHL. However, in this case, capillary hemangioma occurred on fovea, which was accompanied by a decrease in visual acuity. In such cases, visual improvement can be accomplished through photodynamic therapy and intravitreal bevacizumab injection.
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