a choroidal hemangioma is an uncommon benign vascular tumor of the choroid that can be either circumscribed or diffuse . in our experience ,
diffuse choroidal hemangiomas in asian patients often require multiple photodynamic therapy ( pdt ) treatment sessions .
five sessions of pdt treatment were required over a period of 1 year and a final optical coherence tomogram 3 months later revealed resolution of subretinal fluid and the choroidal hemangioma .
this case report illustrates that a single application of pdt using standard published parameters was insufficient to achieve the destruction of the enlarged vessels .
the decision for repeat treatment was based on subretinal fluid recurrence , rather than complete tumor regression .
our case report supports previous suggestions that larger dilated vessels in the vascular network of a choroidal hemangioma might affect the efficacy and selectivity of pdt in treating the eyes of asian patients  which may explain the need for multiple treatments .
choroidal hemangioma is an uncommon benign vascular tumor of the choroid that can be either circumscribed or diffuse.1 diffuse choroidal hemangiomas , usually associated with sturge
 weber syndrome ( sws ) , are more likely to develop secondary retinal detachment.2 diffuse choroidal hemangiomas have been treated using many modalities including radiotherapy , antivascular endothelial growth factor , and photodynamic therapy ( pdt).2 theoretically , pdt has ideal properties for such treatment as it offers site - specific tumor destruction while sparing the overlying retina and retinal vasculature.3 to date , there have been only six case reports of successful single pdt treatment for diffuse choroidal hemangiomas.2 we present a case report to illustrate a case of diffuse choroidal hemangioma that was refractory to a single treatment .
a 7-year - old boy with sws presented with blurring of vision in the left eye ( os ) with increasing hypermetropia ( 8.0 d to 11.0 d ) over a period of 6 months . at presentation , his best - corrected visual acuity ( bcva ) was 20/20 right eye ( od ) and 20/150 os .
fundus examination of the left eye revealed a diffuse , orange choroidal tumor with overlying exudative retinal detachment ( rd ) .
b - scan ultrasound confirmed the presence of a diffuse choroidal hemangioma with thickening of the choroid and associated rd ( figure 1 ) .
verteporfin was infused at a concentration of 6 mg / m , and an 83-second treatment was conducted with a 689 nm visulas 690s photodynamic therapy laser system ( carl zeiss meditec , inc .
, ag , jena , germany ) that was delivered at 50 j / cm with an intensity of 600 mw / cm . five partially overlapping , maximally large spots ( 5200 m ) were applied to the diffuse choroidal hemangioma .
optical coherence tomography was used to monitor treatment response ( figure 1a and figure 2 ) . however , because of persistent choroidal thickening and subretinal fluid , additional sessions of pdt , as described , were applied 2 , 3 , and 4 months post - presentation ( a total of four sessions ) , with persistent subretinal fluid at ocular coherence tomography ( oct ) thicknesses of 557 m , 507 m , and 407 m , respectively .
these further treatments finally resulted in elimination of the subretinal fluid and the overlying exudative rd ( oct retinal thickness at fovea 337 m ) , and bcva improved to 20/40 os .
a year later , on routine follow - up , the patient presented with recurrence of subretinal fluid diagnosed on oct and a reduction in bcva to 20/100 os .
a fifth session of pdt treatment applied and a final oct 3 months later revealed resolution of subretinal fluid and the choroidal hemangioma ( oct retinal thickness at fovea 300 m ) with a stable final bcva of 20/100 os .
this case report exemplifies our experience with asian patients with diffuse choroidal hemangiomas , who often require multiple treatments with pdt ( unpublished ) .
a single application of pdt using currently prescribed parameters is insufficient to destroy the enlarged vessels .
this experience is similar to previous reports from china describing circumscribed choroidal hemangiomas.4 the decision for repeat treatment was based on subretinal fluid recurrence , rather than on complete tumor regression .
however , our patient was refractory to treatment , requiring a total of five pdt sessions .
factors such as timing of laser application , absorption wavelength , and laser dose characteristics influence the efficacy of pdt.5 however , it has been suggested that patients of asian descent may respond differently to pdt treatment,6 possibly due to inherent differences in the retina , such as increased pigmentation in the retinal pigment epithelium . in another study involving chinese patients ,
it was suggested that the larger dilated vessels in the vascular network of a choroidal hemangioma might affect the efficacy and selectivity of pdt.4
diffuse choroidal hemanogiomas associated with sws are uncommon but require aggressive treatment to prevent visual loss from exudative rd , and possibly , subsequent sequelae such as amblyopia
 backgrounda choroidal hemangioma is an uncommon benign vascular tumor of the choroid that can be either circumscribed or diffuse . in our experience , 
 diffuse choroidal hemangiomas in asian patients often require multiple photodynamic therapy ( pdt ) treatment sessions.methodswe here provide a case report of a 7-year - old boy with sturge  weber syndrome who presented with diffuse choroidal hemangioma in the left eye . 
 five sessions of pdt treatment were required over a period of 1 year and a final optical coherence tomogram 3 months later revealed resolution of subretinal fluid and the choroidal hemangioma.resultsfinal visual acuity was 20/100 in the left eye with resolution of subretinal fluid . 
 this case report illustrates that a single application of pdt using standard published parameters was insufficient to achieve the destruction of the enlarged vessels . 
 this experience is similar to previous chinese reports on circumscribed choroidal hemangiomas . 
 the decision for repeat treatment was based on subretinal fluid recurrence , rather than complete tumor regression.conclusionour case report supports previous suggestions that larger dilated vessels in the vascular network of a choroidal hemangioma might affect the efficacy and selectivity of pdt in treating the eyes of asian patients  which may explain the need for multiple treatments . 
Background
Methods
Results
Conclusion
Introduction
Case report
Discussion
Conclusion