A 76-year-old man presented with distorted vision in his left eye, with a best corrected visual acuity of 1.2 and 0.6 in his right and left eyes, respectively. Fundus examination showed
angioid streaks in both eyes and
epiretinal membrane only in the left eye. The patient underwent 23-gauge three-port pars plana
vitrectomy with removal of the
epiretinal membrane combined with
cataract surgery. Internal limiting membrane in addition to the
epiretinal membrane were successfully peeled and removed, with
indocyanine green dye used to visualize the internal limiting membrane. His left best corrected visual acuity improved to 0.8. An elevated lesion with
retinal hemorrhage due to probable
choroidal neovascularization was found between the fovea and the optic disc in the left eye at 7 weeks after surgery. Since best corrected visual acuity decreased to 0.15 and the
hemorrhage expanded, posterior sub-Tenon injection of
triamcinolone acetonide was performed. However, no improvement was observed. Even though intravitreal
bevacizumab injection was performed a total of five times, his best corrected visual acuity remained at 0.1. Subsequently, we performed a combination treatment of a standard-fluence
photodynamic therapy and intravitreal
ranibizumab injection, with additional intravitreal
ranibizumab injections performed 3 times after this combination treatment. Best corrected visual acuity improved to 0.5 and the size of the
choroidal neovascularization markedly regressed at 4 months after the combined treatment.
CONCLUSION: