Beyond Treatment: The Strategy of Nonintervention in Choroidal Hemangioma

The circumscribed choroidal hemangioma (CCH) is a benign congenital eye tumor whose etiology is not clear. A 41-year-old female patient came with a 2-year history of slowly progressive deteriorating vision in her right eye. In the left eye, the best-corrected visual acuity (BCVA) was 6/6, and counting fingers at 1 m in the right eye. The wide-field fundus showed a yellow macular lesion with indistinct limits, which is a sign of serous retinal detachment. B-scan ultrasonography revealed a clear-cut choroidal lesion, high internal reflectivity, and visible intrinsic vascularity on color Doppler. OCT has shown a massive choroidal mass with damaged RPE and outer retinal layers, which has been obscured by serous retinal detachment. The chest x-ray revealed bronchiectatic opacities, the CT scan revealed no lung lesions, and LFTs and RFTs were normal. The fluorescein angiography revealed a choroidal hemangioma with early vascularity and late hyperfluorescence. Nonetheless, the retinal team chose the option of observation instead of TTT, radiotherapy, or verteporfin photodynamic therapy due to the closeness of the lesion to the macula, low visual acuity, and lack of verteporfin PDT in Pakistan. To sum up, the present case demonstrates the significance of multimodal imaging in the proper diagnosis of choroidal hemangiomas and the necessity to pay close attention to patient-specific factors when making treatment decisions, especially in limited resource settings.