Choroidal Hemangiomas

Abstract

Choroidal hemangioma exists in two forms. Circumscribed choroidal hemangioma occurs sporadically in the absence of systemic disease. Diffuse choroidal hemangioma is associated with Sturge-Weber syndrome and Klippel-Trenaunay-Weber syndrome. Clinically, choroidal hemangiomas appear as reddish-orange choroidal masses and are most commonly located posterior to the equator. Associated features such as exudative retinal detachment, overlying intraretinal fluid, and pigmentary changes are common and can result in vision loss. On fluorescein angiography, a fine lacy pattern can be in the early arterial phase. There is early and avid hyperfluorescence that increases throughout the angiogram with variable leakage and washout in later frames. Indocyanine green angiography provides superior visualization of the choroid and demonstrates early, rapid filling with late washout. B-scan ultrasonography demonstrates a dome-shaped or diffuse choroidal mass, and A-scan ultrasonography confirms high internal reflectivity. Photodynamic therapy is frequently employed as first-line treatment for small symptomatic choroidal hemangioma, while larger and more diffuse tumors can be successfully treated with radiation.