A 60-year-old man was referred because of decreased vision in the right eye. He had a history of diabetes mellitus, systemic hypertension, arteriosclerosis obliterans, and renal failure requiring dialysis. The right eye had undergone focal laser photocoagulation in the macula due to uncertain reasons 20 years before the initial visit. Initially, the right eye had subretinal fluid accumulation and hemorrhages in the macula with a visual acuity of 20/200. Moreover, both eyes had retinal microaneurysms and punctate hemorrhages consistent with diabetic retinopathy. Indocyanine green angiography revealed peculiar vascular change in the macula, namely, polypoidal choroidal vasculopathy.1 In the right eye, we performed the first session of PDT according to the standard protocol.2 Verteporfin (Visudyne; Novartis AG, Basel, Switzerland) (6 mg/m2 of body surface area) was infused intravenously over 10 minutes. Fifteen minutes after the start of infusion, a 689-nm laser light (Carl Zeiss, Dublin, California) delivered 50 J/cm2 at an intensity of 600 mW/cm2 for 83 seconds covering the dye leakage on fluorescein angiography (the greatest linear dimension of the entire choroidal neovascularization lesion was 2492 μm; the spot size was 3500 μm). Postoperatively, the right eye showed immediate resolution of exudation with no complications. Two years later, the patient noticed vision loss in his right eye attributable to the relapse of exudative change in the macula, and visual acuity was 20/100 (Figure 1). We performed the second session of PDT in the right eye with the same protocol as the first session (the greatest linear dimension of the entire choroidal neovascularization lesion was 4427 μm; the spot size was 5500 μm). A Volk QuadrAspheric contact lens (Volk Optical, Inc, Mentor, Ohio) was used, giving 1.97× magnification of the laser spot at the retina. One week later, he noted sudden visual deterioration from 1 day following treatment, and visual acuity decreased to 20/400. Biomicroscopic examination revealed a well-demarcated, circular, whitish lesion exactly corresponding to the PDT spot (Figure 2). Fluorescein angiography showed complete occlusions of all retinal arterioles, venules, and capillaries within the treated area. Optical coherence tomography revealed hyperreflective thickening of the involved retina. We performed extensive blood testing; however, no particular findings except hyperglycemia were detected. Three months later, the whitish circular retinal lesion in the macula was indistinct and the exudative change had resolved. However, the irradiated area was not perfused on fluorescein and indocyanine green angiography. The retina was markedly thin with no subretinal fluid in the optical coherence tomographic image, and visual acuity was 20/200.