PHOTODYNAMIC THERAPY WITH VERTEPORFIN PLUS INTRAVITREAL BEVACIZUMAB FOR CIRCUMSCRIBED CHOROIDAL HEMANGIOMA: 4 YEARS OF FOLLOW-UP Andres F. Lasave, MD,*† Martin A. Serrano, MD,† J. Fernando Arevalo, MD, FACS‡ Purpose: To report the anatomical and functional response of combined photodynamic therapy and intravitreal injection of bevacizumab in a patient with symptomatic circum- scribed choroidal hemangioma. Methods: The patient received a single-session full-fluence photodynamic therapy immediately followed by an intravitreal injection of bevacizumab (1.25 mg/0.05 mL). Results: One week after combined therapy, an improvement of best-corrected visual acuity from count fingers to 20/60 and a significant decrease in subretinal fluid were noted. One month later, we observed decreased leakage on fluorescein angiography in all phases of the study. Three months after treatment, the best-corrected visual acuity improved to 20/ 25 and spectral domain optical coherence tomography scans showed return to normal foveal architecture with no subretinal fluid and completely flat tumor. These findings were maintained during 4 years of follow-up. Conclusion: Combination therapy was associated with a rapid and persistent resolution of subretinal fluid, improvement of best-corrected visual acuity, and visual stability at 4 years of follow-up. RETINAL CASES & BRIEF REPORTS 0:1–6, 2017 From the *Retina and Vitreous Service, Clinica Privada de Ojos, Mar del Plata, Argentina; †Retina and Vitreous Service, Clinica Oftalmologica Centro Caracas, Caracas, Venezuela; and ‡Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland. C horoidal hemangioma is a benign vascular ha- martoma that most frequently occurs as a circum- scribed and solitary tumor of the posterior pole. Circumscribed choroidal hemangioma (CCH) is a rare intraocular tumor. In 38% of cases, this tumor is ini- tially misinterpreted before being referred as a choroi- dal melanoma or metastasis. 1 Most hemangiomas show progression with secondary subretinal and in- traretinal fluid and are associated with significant loss of vision, impairment of central visual field, and marked metamorphopsia. 2 Factors related to worsen- ing of visual acuity in these patients include poor visual acuity at presentation, symptoms of meta- morphopsia, multiquadrant subretinal fluid, and chronic retinal pigment epithelial changes. 1 Another variant of this tumor can appear, less commonly, associated with Sturge–Weber syndrome as diffuse choroidal angiomatosis. 2 Treatment is indicated if visual acuity decreases because of secondary exudative retinal detachment, hyperopic shift, degeneration of the retina overlying a subfoveal tumor, or rarely, formation of a neo- vascular choroidal membrane. 3 A number of treatment All authors contributed equally to the manuscript. Supported in part by the Arevalo-Coutinho Foundation for Research in Ophthalmology, Caracas, Venezuela. None of the authors has any financial/conflicting interests to disclose. Reprint requests: J. Fernando Arevalo, MD, FACS, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee 708, Baltimore, MD 21287; e-mail: arevalojf@jhmi.edu 1 Copyright ª by Ophthalmic Communications Society, Inc. Unauthorized reproduction of this article is prohibited.