A 47 year old male patient visited our hospital with the chief complaint ofacute progressive deterioration of the visual acuity of his left eye that had begun 2 months earlier. No specific findings were detected in his prior history. Thetotal cholesterol, component ratio of triglycerides, HDL-cholesterol and LDL-cholesterol were within the normal range. At the initial examination, the corrected visual acuity of his right and left eye was 1.0 and 0.02, respectively. The intraocular pressure of the right and left eye, measured using a non-contact tonometer, was 19 mmHg and 16 mmHg, respectively. The slit lamp examination revealed no specific special findings in the anterior segment and no rubeosis. The bilateral fundus examination showed normal findings in his right eye, and thick macular edema in the posterior pole in his left (
Fig. 1A). Fluorescein angiography revealed profuse leakage with capillary dropout and a club shape thatdiffused to the blood vessels in the vicinity of the posterior pole (
Fig. 1B). OCT showed that the retina thickness had thickened noticeably to 1,187 µm as a result of macular edema (
Fig. 1C). Focal laser photocoagulation was attempted in the dilated vessel area but it was difficult to perform satisfactorily because of the thick retinal edema. The OCT taken 1 week after his first visit did not show any improvement of the macular edema. Therefore, bevacizumab (Avastin™, 25 mg/ml, 4 ml, Roche, USA) 1.25 mg (0.5 ml) was injected into the vitreal cavity in order to subside the retinal edema and facilitate focal laser photocoagulation on the telangiectatic vessels. Additional focal laser photocoagulation was then performed. However, OCT taken at 3 week visit after the injection showed that the macular thickness had barely changed. On the 6th week after treatment, an intravitreal injection of triamcinolone acetonide (Triamcinolone inj®, 40 mg/ml, 5 ml, Dongkwang pharma, Korea) 4 mg (0.1 ml) was performed to resolve the retinal edema for focal laser photocoagulation. One week after the triamcinolone acetonide injection, the visual acuity was 0.02 and showed no improvement. However, there was a noticeable reabsorption of the macular edema. At the 2
nd week after the injection, the foveal structures began to recover. After 5 weeks, the retinal thickness had decreased to 244 µm (
Fig. 2C). The visual acuity improved slightly to 0.04, and additional focal laser photocoagulation could be performed easily and satisfactorily with the absorption of the retinal edema. Repeated focal laser photocoagulation was performed at each visit until 10 weeks after injection, and the retinal edema remained stable. At 6 months, the OCT showed that the macular edema had increased to 680 µm (
Fig. 2D). However, on color fundus photography, thick circinate hard exudates was much absorbed (
Fig. 2A) and, fluorescein angiography revealed a significant decrease in leakage from telangiectactic vessels compared with that performed at the time ofthe initial diagnosis (
Fig. 2B). Consequently, repeated injection of triamcinolone acetonide and repeated aggressive laser photocoagulation was planned in order to prevent further progression.