Title

CIRCUMSCRIBED CHOROIDAL HEMANGIOMA: A SERIE OF CASES

Introduction

Choroidal hemangioma is a benign hamartomatous disorder that occurs in two distinct clinical forms: a circumscribed form that is almost always isolated and nonsyndromic; and a diffuse form that is usually part of the Sturge-Weber syndrome. The circumscribed choroidal hemangioma (CCH) presents itself as a rounded mass in the choroid, with a red-orange color, usually in the posterior pole. The clinical diagnosis is complemented with optical coherence tomography (OCT), ultrasound (USG) and fluorescein angiography. When symptomatic, they can cause low visual acuity due to serous detachments or degenerative changes in the retinal pigment epithelium (RPE) overlying the lesion. The prognosis varies according to the presence or absence of complications.

Methods

Medical record review.

Results

We report two cases of CCH in patients aged 60 and 63 yo who came for routine eye examination. Both had no complaints of low visual acuity and did not report associated diseases. Fundoscopy revealed a nodular, circumscribed, orange-colored lesion in the upper temporal region of the right eye. The AF showed hyperfluorescence due to staining circumscribing the elevated lesion. USG showed an elevated choroid lesion with medium/high intensity echoes. Kappa angle and posterior acoustic shadow were not seen (Image 5). The spectral domain OCT imaging demonstrated a hyporeflective round-shaped retinal elevation. Our diagnosis was a CCH without complications and we decided to maintain clinical follow-up for both patients.

Discussion

Some asymptomatic cases of CCH can be observed. The treatment is directed toward visual loss related to secondary retinal detachment, glaucoma or other complications. In such cases, photodynamic therapy with verteporphyrin (PDT), associated or not with intravitreal anti-VEGF and radiotherapy are some options. PDT is currently regarded as the treatment of choice for such lesions.

Keywords

Choroidal hemangioma, Retinal diseases; Retina/pathology.

Area

CLINICAL CASE

Authors

Andréia Novelli, Paulo Henrique Horizonte, Angelo Sérgio de Francesco Figueiredo, Vitor Gilberto Essi Monticuco, Raimunda Cristina M F de Oliveira, Anésio Ruiz Neto, Beatriz Mello Mencaroni, André Marcelo Vieira Gomes