Pigmentation Artifact of "True-Color" Fundus Photography in Circumscribed Choroidal Hemangiomas

Color characterization plays an important role in the diagnosis of choroidal hemangiomas. Hence, fundus photography is a critical ancillary test in the recognition of this disease. We report a color artifact with "true-color" fundus imaging that can lead to a more pigmented appearance of these lesions resulting in incorrect diagnosis.

This was a single-center retrospective study with chart and imaging review of patients with a diagnosis of choroidal hemangioma from October 2007 to October 2024. Fifteen cases with multimodal confirmation of the diagnosis with fundus photography, indocyanine green angiography, standardized echography, and optical coherence tomography were identified. All cases had fundus imaging with at least 2 different cameras. Pigmentation was graded by a retina specialist and the different fundus photography modalities as well as fundus examinations were compared.

Nine cases had artifactual "true-color" fundus photography with pigmentation. Six cases had a referring diagnosis of choroidal nevus or melanoma. All cases had multimodal imaging with a diagnosis confirming the diagnosis of choroidal hemangioma. Ten of 15 patients received photodynamic therapy, while 5 were observed. The average follow-up for patients was 36 months.

Pigmentation artifact can be present in fundus photography of choroidal hemangiomas even with "true-color" fundus cameras. The Xenon lamp-based cameras tend to produce the most clinically accurate photos. This paper highlights the critical value of the clinical exam for the evaluation of choroidal hemangiomas.