PMC10082599_01
Ancillary testing of the left eye on the patient's initial presentation, revealing a hemangioma superior to the disc with secondary subretinal fluid in the macula. These were visualized with (A) fundus photos, wide-field fluorescein angiography and indocyanine green angiography, respectively; (B) optical coherence tomography over the macula showing foveal detachment (-->) and choroidal elevation from hemangioma (*); (C) B-scan ultrasonography and A-scan ultrasonography.
IMCRJ-16-239-g0001.jpg
PMC10082599_01_IMCRJ-16-239-g0001.jpg
f0001
FA studies revealed leakage from an ill-defined lesion superotemporal to the disc, while the indocyanine-green (ICG) studies showed diffuse and intense hyperfluorescence of choroidal vessels, consistent with a choroidal hemangioma (Figure 1A). Baseline OCT studies over the lesion revealed a smooth dome-like elevation of the retinal pigment epithelium (RPE), associated with a shallow exudative detachment (Figure 1B). B-scan ultrasonography demonstrated a mass lesion with a maximal apical height of 2.32 mm, maximal basal dimensions of 6.68 mm x 7.30 mm, and areas of medium to high internal reflectivity on the A-scan (Figure 1C). 
Optical coherence tomography studies over the macula on the day of treatment with half-fluence PDT and aflibercept (A), three weeks post-treatment (B), five weeks post-treatment (C), and eight weeks post-treatment (D). Columns left to right: horizontal OCT cuts over the fovea, contour map of the central macula, and difference map of macular thickness (microns) between each sequential scan.
IMCRJ-16-239-g0002.jpg
PMC10082599_01_IMCRJ-16-239-g0002.jpg
f0002
On the day of treatment, OCT studies documented a significant amount of subretinal fluid (SRF) within the macula associated with the choroidal hemangioma (Figure 2A). Three weeks after treatment with PDT, intravitreal aflibercept, and topical anti-inflammatory eyedrops, there was dramatic improvement in SRF on the OCT difference map (Figure 2B). SRF (Figure 2C) and VA remained stable at 20/50 OS with stable intraocular pressures of 14 mmHg OD and 18 mmHg OS. Seven and a half weeks after treatment, there was complete resolution of SRF (Figure 2D) and improvement in VA to 20/30 OS; intraocular pressures were 17 mmHg OD and 20 mmHg OS.
Comparison of (A) fundus images and (B) indocyanine-green angiographic images pre- and post-treatment with half-fluence PDT and aflibercept taken at presentation and eleven and a half weeks after treatment.
IMCRJ-16-239-g0003.jpg
PMC10082599_01_IMCRJ-16-239-g0003.jpg
f0003
Eleven and a half weeks after treatment, fundus photos showed a decrease in elevation of the lesion (Figure 3A), and ICG studies showed a decrease in choroidal perfusion associated with hemangioma (Figure 3B).