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Circumscribed choroidal hemangiomas
R Anand1, J J Augsburger, J A Shields
1Wills Eye Hospital, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107.
Insights
Scatter photocoagulation effectively treats retinal detachment caused by choroidal hemangiomas, but long-term vision often remains impaired. Many patients experience temporary visual improvement, yet permanent vision loss is common, especially with foveal involvement.
Area of Science:
- Ophthalmology
- Medical Imaging
- Oncology
Background:
- Circumscribed choroidal hemangiomas are benign vascular tumors.
- These tumors can cause vision-threatening complications like retinal detachment.
- Accurate diagnosis relies on ophthalmoscopy, fluorescein angiography, and ultrasonography.
Purpose of the Study:
- To evaluate the efficacy and long-term visual outcomes of scatter photocoagulation for circumscribed choroidal hemangiomas.
- To assess the impact of tumor location and retinal detachment on visual prognosis.
Main Methods:
- Retrospective observational study of 71 patients with unilateral choroidal hemangiomas.
- Patients underwent diagnostic imaging (ophthalmoscopy, fluorescein angiography, ultrasonography).
- Treatment involved scatter photocoagulation for retinal detachment; visual acuity and follow-up data were analyzed.
Main Results:
- Of 64 followed patients, 42 were treated with scatter photocoagulation for retinal detachment.
- Photocoagulation led to subretinal fluid resolution in all treated eyes and vision stabilization in 53%.
- However, 72% of treated eyes had visual acuity worse than 6/15 at follow-up, with significant long-term vision reduction in many cases.
Conclusions:
- Scatter photocoagulation is effective in achieving retinal reattachment and temporary visual improvement for choroidal hemangioma-related detachment.
- Long-term visual outcomes are often poor, with a high rate of permanent vision decrease, particularly when the fovea is involved.
- A significant proportion of patients may experience a decline in visual acuity over time, necessitating ongoing monitoring.
Abstract:
We report observations of 71 patients with circumscribed choroidal hemangiomas. Each of these patients had a unilateral choroidal tumor with characteristic ophthalmoscopic, fluorescein angiographic, and ultrasonographic features. The affected patients ranged in age from 9 to 86 years when diagnosed. Sixty-four (90%) of the 71 patients were followed up by use after their initial diagnostic examination. The median follow-up was 45.5 months (range, 6 weeks to 12 years). Forty-two of the 64 patients were treated with scatter photocoagulation to the tumor surface on one or more occasions for vision-impairing or vision-threatening nonrhegmatogenous retinal detachment. The subretinal fluid resolved following photocoagulation in all of these eyes, and the vision stabilized in 34 patients (53%). However, the visual acuity at the most recent follow-up was less than 6/15 in 46 (72%) of the 64 affected eyes. Scatter photocoagulation, as employed in this group of patients, frequently results in retinal reattachment and temporary visual improvement, but many patients have permanently decreased vision in the affected eye, particularly when the tumor or the retinal detachment affects the foveal area. One third of the patients with 6/60 or better visual acuity at presentation are estimated to deteriorate to less than 6/60 visual acuity within 10 years.