Circumscribed choroidal hemangioma: Clinical features and outcomes by age category in 458 cases
Lauren A Dalvin1,2, Li-Anne S Lim1, Michael Chang1
1Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107, United States.
Insights
Younger patients with circumscribed choroidal hemangioma (CCH) experience worse vision and larger tumors. Early detection and tailored treatments are crucial for this pediatric subgroup.
Area of Science:
- Ophthalmology
- Oncology
- Medical Research
Background:
- Circumscribed choroidal hemangioma (CCH) is a benign vascular tumor of the choroid.
- Tumor characteristics and patient outcomes can vary significantly based on age at diagnosis.
Purpose of the Study:
- To investigate the distinct features and treatment outcomes of CCH in relation to patient age at presentation.
- To identify potential differences in clinical presentation and management strategies across different age groups.
Main Methods:
- A retrospective review was conducted on 458 cases of CCH diagnosed between 1967 and 2018.
- Patients were stratified into three age groups: ≤20 years, >20-50 years, and >50 years.
- Clinical data, including tumor characteristics, visual acuity, treatment modalities, and follow-up outcomes, were analyzed.
Main Results:
- The youngest age group (≤20 years) presented with significantly worse visual acuity, larger tumor basal diameter, greater tumor thickness, and closer proximity to the foveola.
- Younger patients were more likely to receive plaque or external beam radiotherapy and required more treatment sessions.
- Despite differences in initial presentation and treatment intensity, long-term visual acuity loss of 3 or more Snellen lines did not significantly differ across age groups.
Conclusions:
- Pediatric patients (≤20 years) with CCH exhibit unique clinical features, including poorer visual acuity and more extensive tumors.
- The findings highlight the need for improved early detection and age-specific treatment strategies for CCH in younger individuals.
- Further research is warranted to optimize management protocols for this vulnerable patient subgroup.
Purpose:
To investigate features and outcomes of circumscribed choroidal hemangioma by patient age.
Methods:
Retrospective review of circumscribed choroidal hemangioma from 3/29/1967-6/4/2018 based on age at presentation (≤20 vs. >20-50 vs. >50 years).
Results:
There were 458 circumscribed choroidal hemangiomas diagnosed at mean age (13 vs. 41 vs. 64 years, p < 0.001). The youngest age group had worse presenting visual acuity (20/400 vs. 20/150 vs. 20/100, p < 0.001), larger tumor basal diameter (13.5 vs. 6.6 vs. 6.2, p < 0.001), greater tumor thickness (5.8 vs. 3.1 vs. 2.9, p < 0.001), closer distance to foveola (0.5 vs. 1.4 vs. 1.2, p = 0.03), and greater extent of subretinal fluid (4 quadrants, 26% vs. 8% vs. 2%, p < 0.001). The youngest patients were less likely to be treated with primary observation (39% vs. 39% vs. 56%) or photodynamic therapy (10% vs. 27% vs. 22%) and more likely to be treated with plaque radiotherapy (26% vs. 6% vs. 3%) or external beam radiotherapy (13% vs. 1% vs. 0%) (p < 0.001). The youngest patients required greater total number of treatments (mean 4 vs. 2 vs. 1, p < 0.001). At mean follow-up (44 vs. 68 vs. 60 months, p = 0.37), the youngest patients had worse visual acuity (20/400 vs. 20/200 vs. 20/100, p = 0.03), but no difference in visual acuity loss of 3 or more Snellen lines (27% vs. 13% vs. 16%, p = 0.55).
Conclusion:
Younger patients (≤20 years) with circumscribed choroidal hemangioma present with worse visual acuity and larger, more posterior tumors. Future studies are needed to improve early detection and treatment for this subgroup of patients.
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