Supplementary Material for: Bevacizumab and external beam radiation therapy for diffuse choroidal hemangioma in Sturge-Weber Syndrome: a case report

Introduction: Sturge-Weber Syndrome, a congenital vascular disorder, is associated with diffuse choroidal hemangiomas in which the current mainstay of treatment is radiation therapy, including external beam radiation therapy (EBRT). The purpose of this case report is to present a novel combination of treatments for diffuse choroidal hemangioma.
Case Presentation: A 37-year-old man with history of Sturge-Weber associated glaucoma presented with acute-onset decrease in vision in the right eye. Best-corrected visual acuity (BCVA) at presentation was 20/400 in the right eye. Examination revealed a macula-off total, bullous, folded exudative retinal detachment and findings consistent with diffuse choroidal hemangioma. The patient was treated with a single injection of intravitreal anti-vascular endothelial growth factor (anti-VEGF) bevacizumab and 10 fractions of external beam radiation therapy of the right eye. Follow-up examination at 17 months demonstrated complete resolution of subretinal fluid and no evidence of choroidal elevation on B-scan. Final BCVA in the right eye was 20/1000.
Discussion: This case uses simultaneous treatment with EBRT and bevacizumab in the treatment of diffuse choroidal hemangioma and associated exudative retinal detachment. Clinicians may use anti-VEGF agents early in the course of the disease in determining whether they may assist in preventing visual decline.