Choroidal Hemangioma and Its Management

  • Shweta Gupta
  • Swathi Kaliki


Choroidal hemangioma is a vascular tumor, which can either be circumscribed or diffuse. It most commonly occurs in the posterior pole as a reddish-orange choroidal mass. Ancillary testing with ultrasonography, indocyanine green angiography, and optical coherence tomography are useful in making an accurate diagnosis. The lesion can be simply observed when not associated with any signs of tumor activity. When associated with signs of tumor activity, the treatment options include photodynamic therapy, transpupillary thermotherapy, laser photocoagulation, plaque radiotherapy, external beam radiotherapy, proton beam radiotherapy, anti-vasoendothelial growth factors, or oral beta-blockers. The lesions respond well to treatment with excellent visual recovery.


Eye Tumor Choroid Hemangioma PDT 


  1. 1.
    Shields JA, Shields CL. Intraocular tumors: a text and atlas. Philadelphia: W.B. Saunders Company; 1992.Google Scholar
  2. 2.
    Schepens CL, Schwartz A. Intraocular tumors: I. Bilateral hemangioma of the choroid. Arch Ophthalmol. 1958;60(1):72–83.CrossRefGoogle Scholar
  3. 3.
    Lindsey PS, Shields JA, Goldberg RE, Augsburger JJ, Frank PE. Bilateral choroidal hemangiomas and facial nevus flammeus. Retina. 1981;1(2):88–95.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Fukuda T, Shimada N, Ishida T, Furuse Y, Tobita H, Ohno-Matsui K. Bilateral circumscribed choroidal hemangioma with retinal and choroidal venous abnormalities. Jpn J Ophthalmol. 2011;55(6):688–90.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Shields CL, Honavar SG, Shields JA, Cater J, Demirci H. Circumscribed choroidal hemangioma: clinical manifestations and factors predictive of visual outcome in 200 consecutive cases. Ophthalmology. 2001;108(12):2237–48.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Turell ME, Singh AD. Vascular tumors of the retina and choroid: diagnosis and treatment. Middle East Afr J Ophthalmol. 2010;17(3):191–200.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Bonnet M, Francoz-Taillanter N. Cavernous hemangioma of the choroid (clinical review of 10 cases). Bull Soc Ophtalmol Fr. 1980;81(4-5):455–8.Google Scholar
  8. 8.
    Anand R, Augsburger JJ, Shields JA. Circumscribed choroidal hemangiomas. Arch Ophthalmol. 1989;107(9):1338–42.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Shields CL, Shields JA, De Potter P. Patterns of indocyanine green videoangiography of choroidal tumours. Br J Ophthalmol. 1995;79(3):237–45.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Heimann H, Jmor F, Damato B. Imaging of retinal and choroidal vascular tumours. Eye. 2013;27(2):208–16.CrossRefGoogle Scholar
  11. 11.
    Schalenbourg A, Piguet B, Zografos L. Indocyanine green angiographic findings in choroidal hemangiomas: a study of 75 cases. Ophthalmologica. 2000;214(4):246–52.CrossRefGoogle Scholar
  12. 12.
    Blasi MA, Tiberti AC, Scupola A, Balestrazzi A, Colangelo E, Valente P, et al. Photodynamic therapy with verteporfin for symptomatic circumscribed choroidal hemangioma: five-year outcomes. Ophthalmology. 2010 Aug;117(8):1630–7.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Shields CL, Pellegrini M, Ferenczy SR, Shields JA. Enhanced depth imaging optical coherence tomography of intraocular tumors: from placid to seasick to rock and rolling topography—the 2013 Francesco Orzalesi lecture. Retina. 2014;34(8):1495–512.PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Torres VLL, Brugnoni N, Kaiser PK, Singh AD. Optical coherence tomography enhanced depth imaging of choroidal tumors. Am J Ophthalmol. 2011;151(4):586–593.e2.CrossRefGoogle Scholar
  15. 15.
    Filloy A, Caminal JM, Arias L, Jordán S, Català J. Swept source optical coherence tomography imaging of a series of choroidal tumours. Can J Ophthalmol. 2015;50(3):242–8.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Flores-Moreno I, Caminal JM, Arias-Barquet L, Rubio-Caso MJ, Catala-Mora J, Vidal-Martí M, et al. En face mode of swept-source optical coherence tomography in circumscribed choroidal haemangioma. Br J Ophthalmol. 2016;100(3):360–4.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Sayanagi K, Pelayes DE, Kaiser PK, Singh AD. 3D spectral domain optical coherence tomography findings in choroidal tumors. Eur J Ophthalmol. 2011;21(3):271–5.CrossRefGoogle Scholar
  18. 18.
    Shields CL, Materin MA, Shields JA. Review of optical coherence tomography for intraocular tumors. Curr Opin Ophthalmol. 2005;16(3):141–54.CrossRefGoogle Scholar
  19. 19.
    Kwon HJ, Kim M, Lee CS, Lee SC. Treatment of serous macular detachment associated with circumscribed choroidal hemangioma. Am J Ophthalmol. 2012;154(1):137–45.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Zhang Y, Liu W, Fang Y, Qian J, Xu G, Wang W, et al. Photodynamic therapy for symptomatic circumscribed macular choroidal hemangioma in Chinese patients. Am J Ophthalmol. 2010;150(5):710–715.e1.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Ramasubramanian A, Shields CL, Harmon SA, Shields JA. Autofluorescence of choroidal hemangioma in 34 consecutive eyes. Retina. 2010;30(1):16–22.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    De Potter P, Shields JA, Shields CL. Tumors of the uvea. In: MRI of the eye and orbit. Philadelphia, PA: JB Lippincott Company; 1995. p. 304.Google Scholar
  23. 23.
    Witschel H, Font RL. Hemangioma of the choroid. A clinicopathologic study of 71 cases and a review of the literature. Surv Ophthalmol. 1976;20(6):415–31.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Stephens RF, Shields JA. Diagnosis and management of cancer metastatic to the uvea: a study of 70 cases. Ophthalmology. 1979;86(7):1336–49.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Benson WE, Shields JA, Tasman W, Crandall AS. Posterior scleritis a cause of diagnostic confusion. Arch Ophthalmol. 1979;97(8):1482–6.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Newman DK. Photodynamic therapy: current role in the treatment of chorioretinal conditions. Eye. 2016;30(2):202–10.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Humphrey WT. Choroidal hemangioma: response to cryotherapy. Ann Ophthalmol. 1979;11(1):100–4.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Madreperla SA, Hungerford JL, Plowman PN, Laganowski HC, Gregory PT. Choroidal hemangiomas: visual and anatomic results of treatment by photocoagulation or radiation therapy. Ophthalmology. 1997;104(11):1773–8; discussion 1779PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Sanborn GE, Augsburger JJ, Shields JA. Treatment of circumscribed choroidal hemangiomas. Ophthalmology. 1982;89(12):1374–80.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Shields JA. The expanding role of laser photocoagulation for intraocular tumors: the 1993 H. Christian Zweng memorial lecture. Retina. 1994;14(4):310–22.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Gündüz K. Transpupillary thermotherapy in the management of circumscribed choroidal hemangioma. Surv Ophthalmol. 2004;49(3):316–27.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Kamal A, Watts AR, Rennie IG. Indocyanine green enhanced transpupillary thermotherapy of circumscribed choroidal haemangioma. Eye. 2000;14(5):701–5.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Garcı́a-Arumı́ J, Sararols Ramsay L, Corcostegui Guraya B. Transpupillary thermotherapy for circumscribed choroidal hemangiomas. Ophthalmology. 2000;107(2):351–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Elizalde J, Vasquez L, Iyo F, Abengoechea S. Photodynamic therapy in the management of circumscribed choroidal hemangioma. Can J Ophthalmol. 2012;47(1):16–20.PubMedCrossRefGoogle Scholar
  35. 35.
    Pilotto E, Urban F, Parrozzani R, Midena E. Standard versus bolus photodynamic therapy in circumscribed choroidal hemangioma: functional outcomes. Eur J Ophthalmol. 2011;21(4):452–8.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Scott TA, Augsburger JJ, Brady LW, Hernandez C, Woodleigh R. Low dose ocular irradiation for diffuse choroidal hemangiomas associated with bullous nonrhegmatogenous retinal detachment. Retina. 1991;11(4):389–93.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Alberti WE. Clinical features and management of choroidal hemangiomas, including those occurring in association with Sturge-Weber syndrome. In: Albert WE, Sagerman RH, editors. Radiotherapy of intraocular and orbital tumors. Berlin: Springer; 1993. p. 87–92.CrossRefGoogle Scholar
  38. 38.
    Madreperla SA. Choroidal hemangioma treated with photodynamic therapy using verteporfin. Arch Ophthalmol. 2001;119(11):1606–10.CrossRefGoogle Scholar
  39. 39.
    Landau IME, Steen B, Seregard S. Photodynamic therapy for circumscribed choroidal haemangioma. Acta Ophthalmol Scand. 2002;80(5):531–6.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Porrini G, Giovannini A, Amato G, Ioni A, Pantanetti M. Photodynamic therapy of circumscribed choroidal hemangioma. Ophthalmology. 2003;110(4):674–80.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Barbazetto I, Schmidt-Erfurth U. Photodynamic therapy of choroidal hemangioma: two case reports. Graefes Arch Clin Exp Ophthalmol. 2000;238(3):214–21.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Jurklies B, Anastassiou G, Ortmans S, Schüler A, Schilling H, Schmidt-Erfurth U, et al. Photodynamic therapy using verteporfin in circumscribed choroidal haemangioma. Br J Ophthalmol. 2003;87(1):84–9.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Schmidt-Erfurth UM, Michels S, Kusserow C, Jurklies B, Augustin AJ. Photodynamic therapy for symptomatic choroidal hemangioma: visual and anatomic results. Ophthalmology. 2002;109(12):2284–94.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Verbraak FD, Schlingemann RO, Keunen JEE, de Smet MD. Longstanding symptomatic choroidal hemangioma managed with limited PDT as initial or salvage therapy. Graefes Arch Clin Exp Ophthalmol. 2003;241(11):891–8.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Singh AD, Kaiser PK, Sears JE, Gupta M, Rundle PA, Rennie IG. Photodynamic therapy of circumscribed choroidal haemangioma. Br J Ophthalmol. 2004;88(11):1414–8.PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Boixadera A, Arumí JG, Martínez-Castillo V, Encinas JL, Elizalde J, Blanco-Mateos G, et al. Prospective clinical trial evaluating the efficacy of photodynamic therapy for symptomatic circumscribed choroidal hemangioma. Ophthalmology. 2009;116(1):100–105.e1.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Singh AD. Ocular phototherapy. Eye. 2013;27(2):190–8.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Jurklies B, Bornfeld N. The role of photodynamic therapy in the treatment of symptomatic choroidal hemangioma. Graefes Arch Clin Exp Ophthalmol. 2005;243(5):393–6.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Schmidt-Erfurth UM, Kusserow C, Barbazetto IA, Laqua H. Benefits and complications of photodynamic therapy of papillary capillary hemangiomas. Ophthalmology. 2002;109(7):1256–66.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Xiao Y, Guo X, Ouyang P. Branch retinal artery occlusion associated with photodynamic therapy in a circumscribed choroidal haemangioma. Photodiagn Photodyn Ther. 2013;10(4):644–6.CrossRefGoogle Scholar
  51. 51.
    Ritland JS, Eide N, Tausjø J. External beam irradiation therapy for choroidal haemangiomas. Visual and anatomical results after a dose of 20 to 25 Gy. Acta Ophthalmol Scand. 2001;79(2):184–6.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Karimi S, Nourinia R, Mashayekhi A. Circumscribed choroidal hemangioma. J Ophthalmic Vis Res. 2015;10(3):320–8.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Schilling H, Sauerwein W, Lommatzsch A, Friedrichs W, Brylak S, Bornfeld N, et al. Long term results after low dose ocular irradiation for choroidal haemangiomas. Br J Ophthalmol. 1997;81(4):267–73.PubMedPubMedCentralCrossRefGoogle Scholar
  54. 54.
    Zografos L, Egger E, Bercher L, Chamot L, Munkel G. Proton beam irradiation of choroidal hemangiomas. Am J Ophthalmol. 1998;126(2):261–8.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Hannouche D, Frau E, Desjardins L, Cassoux N, Habrand JL, Offret H. Efficacy of proton therapy in circumscribed choroidal hemangiomas associated with serious retinal detachment. Ophthalmology. 1997;104(11):1780–4.PubMedCrossRefPubMedCentralGoogle Scholar
  56. 56.
    Lee V, Hungerford JL. Proton beam therapy for posterior pole circumscribed choroidal haemangioma. Eye. 1998;12(6):925–8.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Zografos L, Bercher L, Chamot L, Gailloud C, Raimondi S, Egger E. Cobalt-60 treatment of choroidal hemangiomas. Am J Ophthalmol. 1996;121(2):190–9.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Lopez-Caballero C, Saornil MA, De Frutos J, Bianciotto C, Muiños Y, Almaraz A, et al. High-dose iodine-125 episcleral brachytherapy for circumscribed choroidal haemangioma. Br J Ophthalmol. 2010;94(4):470–3.CrossRefGoogle Scholar
  59. 59.
    Aizman A, Finger PT, Shabto U, Szechter A, Berson A. Palladium 103 (103Pd) plaque radiation therapy for CircumscribedChoroidal hemangioma with retinal detachment. Arch Ophthalmol. 2004;122(11):1652–6.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Mandal S, Naithani P, Venkatesh P, Garg S. Intravitreal bevacizumab (avastin) for circumscribed choroidal hemangioma. Indian J Ophthalmol. 2011;59(3):248–51.PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    Sagong M, Lee J, Chang W. Application of intravitreal bevacizumab for circumscribed choroidal hemangioma. Korean J Ophthalmol. 2009;23(2):127–31.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Sanz-Marco E, Gallego R, Diaz-Llopis M. Oral propranolol for circumscribed choroidal hemangioma. Case Rep Ophthalmol. 2011;2(1):84–90.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Tanabe H, Sahashi K, Kitano T, Tomita Y, Saito AM, Hirose H. Effects of oral propranolol on circumscribed choroidal hemangioma: a pilot study. JAMA Ophthalmol. 2013;131(12):1617–22.PubMedCrossRefPubMedCentralGoogle Scholar
  64. 64.
    Sullivan TJ, Clarke MP, Morin JD. The ocular manifestations of the Sturge-Weber syndrome. J Pediatr Ophthalmol Strabismus. 1992;29(6):349–56.PubMedPubMedCentralGoogle Scholar
  65. 65.
    Susac JO, Smith JL, Scelfo RJ. The tomato-catsup fundus in Sturge-Weber syndrome. Arch Ophthalmol. 1974;92(1):69–70.PubMedCrossRefPubMedCentralGoogle Scholar
  66. 66.
    Shanmugam PM, Ramanjulu R. Vascular tumors of the choroid and retina. Indian J Ophthalmol. 2015;63(2):133–40.PubMedPubMedCentralCrossRefGoogle Scholar
  67. 67.
    Abdolrahimzadeh S, Scavella V, Felli L, Cruciani F, Contestabile MT, Recupero SM. Ophthalmic alterations in the Sturge-Weber syndrome, Klippel-Trenaunay syndrome, and the Phakomatosis Pigmentovascularis: an independent group of conditions? Biomed Res Int. 2015;2015:1–11.Google Scholar
  68. 68.
    Hussain RN, Jmor F, Damato B, Heimann H. Verteporfin photodynamic therapy for the treatment of choroidal haemangioma associated with Sturge-Weber syndrome. Photodiagn Photodyn Ther. 2016;15(Supplement C):143–6.CrossRefGoogle Scholar
  69. 69.
    Grant LW, Anderson C, Macklis RM, Singh AD. Low dose irradiation for diffuse choroidal hemangioma. Ophthalmic Genet. 2008;29(4):186–8.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Gottlieb JL, Murray TG, Gass JDM. Low-dose external beam irradiation for bilateral diffuse choroidal hemangioma. Arch Ophthalmol. 1998;116(6):815–7.PubMedPubMedCentralGoogle Scholar
  71. 71.
    Yonekawa Y, MacDonald SM, Shildkrot Y, Mukai S. Standard fractionation low-dose proton radiotherapy for diffuse choroidal hemangiomas in pediatric Sturge-Weber syndrome. J Am Assoc Pediatr Ophthalmol Strabismus. 2013;17(3):318–22.CrossRefGoogle Scholar
  72. 72.
    Murthy R, Hanovar S, Naik M, Gopi S, Reddy VA. Ruthenium-106 plaque brachytherapy for the treatment of diffuse choroidal haemangioma in Sturge-Weber syndrome. Indian J Ophthalmol. 2005;73:274–5.Google Scholar
  73. 73.
    Arepalli S, Shields CL, Kaliki S, Emrich J, Komarnicky L, Shields JA. Diffuse choroidal hemangioma management with plaque radiotherapy in 5 cases. Ophthalmology. 2013;120(11):2358–9.PubMedCrossRefPubMedCentralGoogle Scholar
  74. 74.
    Tsipursky MS, Golchet PR, Jampol LM. Photodynamic therapy of choroidal hemangioma in Sturge-Weber syndrome, with a review of treatments for diffuse and circumscribed choroidal hemangiomas. Surv Ophthalmol. 2011;56(1):68–85.PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Monteiro S, Casal I, Santos M, Meireles A. Photodynamic therapy for diffuse choroidal hemangioma in Sturge-Weber syndrome [internet]. Case Rep Med. 2014;2014:452372. PubMedPubMedCentralCrossRefGoogle Scholar
  76. 76.
    Anand R. Photodynamic therapy for diffuse choroidal hemangioma associated with Sturge weber syndrome. Am J Ophthalmol. 2003;136(4):758–60.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Cacciamani A, Scarinci F, Parravano M, Giorno P, Varano M. Choroidal thickness changes with photodynamic therapy for a diffuse choroidal hemangioma in Sturge-Weber syndrome. Int Ophthalmol. 2014;34(5):1131–5.PubMedCrossRefGoogle Scholar
  78. 78.
    Singh AD, Rundle PA, Vardy SJ, Rennie IG. Photodynamic therapy of choroidal haemangioma associated with Sturge-Weber syndrome. Eye (Lond). 2005;19(3):365–7.CrossRefGoogle Scholar
  79. 79.
    Shoeibi N, Ahmadieh H, Abrishami M, Poorzand H. Rapid and sustained resolution of serous retinal detachment in Sturge-Weber syndrome after single injection of intravitreal bevacizumab. Ocul Immunol Inflamm. 2011;19(5):358–60.PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Paulus Y, Jain A, M Moshfeghi D. Resolution of persistent exudative retinal detachment in a case of Sturge-Weber syndrome with anti-VEGF administration. Ocul Immunol Inflamm. 2009;17:292–4.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Arevalo JF, Arias JD, Serrano MA. Oral propranolol for exudative retinal detachment in diffuse choroidal hemangioma. Arch Ophthalmol. 2011;129(10):1373–5.CrossRefGoogle Scholar
  82. 82.
    Mandal AK. Primary combined trabeculotomy-trabeculectomy for early-onset glaucoma in Sturge-Weber syndrome. Ophthalmology. 1999;106(8):1621–7.PubMedCrossRefPubMedCentralGoogle Scholar
  83. 83.
    Addison PKF, Papadopoulos M, Nischal KK, Hykin PG. Serous retinal detachment induced by topical bimatoprost in a patient with Sturge–Weber syndrome. Eye. 2011;25(1):124–5.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2020

Authors and Affiliations

  • Shweta Gupta
    • 1
  • Swathi Kaliki
    • 1
  1. 1.The Operation Eyesight Universal Institute for Eye Cancer (SG, SK), L V Prasad Eye InstituteHyderabadIndia

Personalised recommendations