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Management of Choroidal Hemangioma

  • Brent E. Aebi
  • Denis JusufbegovicEmail author
Chapter
Part of the Current Practices in Ophthalmology book series (CUPROP)

Abstract

Choroidal hemangioma, a benign vascular tumor, exists in two clinically distinct forms as either a circumscribed or a diffuse lesion and typically involves the posterior pole. Most patients present with decreased visual acuity secondary to subretinal fluid (SRF). In addition to exam, optical coherence tomography (OCT), ultrasonography, fluorescein (FA) and indocyanine green (ICGA) angiography, and magnetic resonance imaging (MRI) all play a role in the diagnosis of choroidal hemangioma. This chapter explores various approaches to therapy, both historical and current, used to treat this choroidal tumor and secondary exudative retinal detachment (ERD). Treatment modalities include laser photocoagulation, transpupillary thermotherapy, photodynamic therapy (PDT), intravitreal anti-VEGF or steroid injection, systemic beta-blockers, plaque brachytherapy, proton beam irradiation, external beam radiotherapy, and gamma knife irradiation. There are many considerations to treatment which include size of the tumor, presence or absence of exudative retinal detachment, prior treatment failures, patient’s ability to undergo surgery, and other comorbidities. Time between onset of symptoms and treatment has been shown to affect visual prognosis.

Keywords

Circumscribed choroidal hemangioma Diffuse choroidal hemangioma Choroidal mass Subretinal fluid Exudative retinal detachment Anti-VEGF Intravitreal injection Beta-blockers Propranolol Laser photocoagulation Transpupillary thermotherapy Photodynamic therapy PDT Brachytherapy External beam radiotherapy Gamma knife Proton beam radiotherapy Sturge-Weber syndrome Tumor 

Abbreviations

CCH

Circumscribed choroidal hemangioma

CME

Cystoid macular edema

CNV

Choroidal neovascularization

DCH

Diffuse choroidal hemangioma

ERD

Exudative retinal detachment

FA

Fluorescein angiography

ICG-A

Indocyanine green angiography

IVB

Intravitreal bevacizumab

IVT

Intravitreal triamcinolone

LSRT

Lens-sparing radiotherapy

MRI

Magnetic resonance imaging

NVD

Neovascularization of the disc

NVE

Retinal neovascularization elsewhere

OCT

Optical coherence tomography

OCT-A

Optical coherence tomography angiography

PDT

Photodynamic therapy

RPE

Retinal pigment epithelium

SRF

Subretinal fluid

SWS

Sturge-Weber syndrome

TTT

Transpupillary thermotherapy

VEGF

Vascular endothelial growth factor

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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of OphthalmologyIndiana University School of Medicine, Eugene and Marilyn Glick Eye InstituteIndianapolisUSA

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