Ruthenium-106 brachytherapy and intravitreal bevacizumab for retinal capillary hemangioma

The purpose of this study is to report a case of retinal capillary hemangioma treated with ruthenium-106 brachytherapy combined with intravitreal bevacizumab. A 58-year-old woman presented with blurred vision in her left eye for 15 days. Best-corrected visual acuity (BCVA) was counting fingers at 3 m in her left eye. Examination showed a peripheral endophytic retinal capillary hemangioma, with associated macular edema and diffuse hard exudates in a macular star pattern. B-scan ultrasonography revealed a solid, highly reflective retinal tumor measuring 7.1 × 7.5 mm in basal dimension and 3.5 mm in thickness. The hemangioma and macular edema were treated with ruthenium-106 brachytherapy (500 Gy) followed 1 month later with an intravitreal injection of 1.25 mg (0.05 ml) bevacizumab. After 10 months of follow-up, examination demonstrated involution of the hemangioma, resolution of the macular edema, less hard exudates, and improvement of BCVA to 20/25. Ruthenium-106 brachytherapy combined with intravitreal bevacizumab was associated with significant involution of the choroidal hemangioma with resolution of the macular edema and improvement in visual acuity.