Abstract
Choroidal hemangioma is a vascular tumor, which can either be circumscribed or diffuse. It most commonly occurs in the posterior pole as a reddish-orange choroidal mass. Ancillary testing with ultrasonography, indocyanine green angiography, and optical coherence tomography are useful in making an accurate diagnosis. The lesion can be simply observed when not associated with any signs of tumor activity. When associated with signs of tumor activity, the treatment options include photodynamic therapy, transpupillary thermotherapy, laser photocoagulation, plaque radiotherapy, external beam radiotherapy, proton beam radiotherapy, anti-vasoendothelial growth factors, or oral beta-blockers. The lesions respond well to treatment with excellent visual recovery.
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References
Shields JA, Shields CL. Intraocular tumors: a text and atlas. Philadelphia: W.B. Saunders Company; 1992.
Schepens CL, Schwartz A. Intraocular tumors: I. Bilateral hemangioma of the choroid. Arch Ophthalmol. 1958;60(1):72–83.
Lindsey PS, Shields JA, Goldberg RE, Augsburger JJ, Frank PE. Bilateral choroidal hemangiomas and facial nevus flammeus. Retina. 1981;1(2):88–95.
Fukuda T, Shimada N, Ishida T, Furuse Y, Tobita H, Ohno-Matsui K. Bilateral circumscribed choroidal hemangioma with retinal and choroidal venous abnormalities. Jpn J Ophthalmol. 2011;55(6):688–90.
Shields CL, Honavar SG, Shields JA, Cater J, Demirci H. Circumscribed choroidal hemangioma: clinical manifestations and factors predictive of visual outcome in 200 consecutive cases. Ophthalmology. 2001;108(12):2237–48.
Turell ME, Singh AD. Vascular tumors of the retina and choroid: diagnosis and treatment. Middle East Afr J Ophthalmol. 2010;17(3):191–200.
Bonnet M, Francoz-Taillanter N. Cavernous hemangioma of the choroid (clinical review of 10 cases). Bull Soc Ophtalmol Fr. 1980;81(4-5):455–8.
Anand R, Augsburger JJ, Shields JA. Circumscribed choroidal hemangiomas. Arch Ophthalmol. 1989;107(9):1338–42.
Shields CL, Shields JA, De Potter P. Patterns of indocyanine green videoangiography of choroidal tumours. Br J Ophthalmol. 1995;79(3):237–45.
Heimann H, Jmor F, Damato B. Imaging of retinal and choroidal vascular tumours. Eye. 2013;27(2):208–16.
Schalenbourg A, Piguet B, Zografos L. Indocyanine green angiographic findings in choroidal hemangiomas: a study of 75 cases. Ophthalmologica. 2000;214(4):246–52.
Blasi MA, Tiberti AC, Scupola A, Balestrazzi A, Colangelo E, Valente P, et al. Photodynamic therapy with verteporfin for symptomatic circumscribed choroidal hemangioma: five-year outcomes. Ophthalmology. 2010 Aug;117(8):1630–7.
Shields CL, Pellegrini M, Ferenczy SR, Shields JA. Enhanced depth imaging optical coherence tomography of intraocular tumors: from placid to seasick to rock and rolling topography—the 2013 Francesco Orzalesi lecture. Retina. 2014;34(8):1495–512.
Torres VLL, Brugnoni N, Kaiser PK, Singh AD. Optical coherence tomography enhanced depth imaging of choroidal tumors. Am J Ophthalmol. 2011;151(4):586–593.e2.
Filloy A, Caminal JM, Arias L, Jordán S, Català J. Swept source optical coherence tomography imaging of a series of choroidal tumours. Can J Ophthalmol. 2015;50(3):242–8.
Flores-Moreno I, Caminal JM, Arias-Barquet L, Rubio-Caso MJ, Catala-Mora J, Vidal-Martí M, et al. En face mode of swept-source optical coherence tomography in circumscribed choroidal haemangioma. Br J Ophthalmol. 2016;100(3):360–4.
Sayanagi K, Pelayes DE, Kaiser PK, Singh AD. 3D spectral domain optical coherence tomography findings in choroidal tumors. Eur J Ophthalmol. 2011;21(3):271–5.
Shields CL, Materin MA, Shields JA. Review of optical coherence tomography for intraocular tumors. Curr Opin Ophthalmol. 2005;16(3):141–54.
Kwon HJ, Kim M, Lee CS, Lee SC. Treatment of serous macular detachment associated with circumscribed choroidal hemangioma. Am J Ophthalmol. 2012;154(1):137–45.
Zhang Y, Liu W, Fang Y, Qian J, Xu G, Wang W, et al. Photodynamic therapy for symptomatic circumscribed macular choroidal hemangioma in Chinese patients. Am J Ophthalmol. 2010;150(5):710–715.e1.
Ramasubramanian A, Shields CL, Harmon SA, Shields JA. Autofluorescence of choroidal hemangioma in 34 consecutive eyes. Retina. 2010;30(1):16–22.
De Potter P, Shields JA, Shields CL. Tumors of the uvea. In: MRI of the eye and orbit. Philadelphia, PA: JB Lippincott Company; 1995. p. 304.
Witschel H, Font RL. Hemangioma of the choroid. A clinicopathologic study of 71 cases and a review of the literature. Surv Ophthalmol. 1976;20(6):415–31.
Stephens RF, Shields JA. Diagnosis and management of cancer metastatic to the uvea: a study of 70 cases. Ophthalmology. 1979;86(7):1336–49.
Benson WE, Shields JA, Tasman W, Crandall AS. Posterior scleritis a cause of diagnostic confusion. Arch Ophthalmol. 1979;97(8):1482–6.
Newman DK. Photodynamic therapy: current role in the treatment of chorioretinal conditions. Eye. 2016;30(2):202–10.
Humphrey WT. Choroidal hemangioma: response to cryotherapy. Ann Ophthalmol. 1979;11(1):100–4.
Madreperla SA, Hungerford JL, Plowman PN, Laganowski HC, Gregory PT. Choroidal hemangiomas: visual and anatomic results of treatment by photocoagulation or radiation therapy. Ophthalmology. 1997;104(11):1773–8; discussion 1779
Sanborn GE, Augsburger JJ, Shields JA. Treatment of circumscribed choroidal hemangiomas. Ophthalmology. 1982;89(12):1374–80.
Shields JA. The expanding role of laser photocoagulation for intraocular tumors: the 1993 H. Christian Zweng memorial lecture. Retina. 1994;14(4):310–22.
Gündüz K. Transpupillary thermotherapy in the management of circumscribed choroidal hemangioma. Surv Ophthalmol. 2004;49(3):316–27.
Kamal A, Watts AR, Rennie IG. Indocyanine green enhanced transpupillary thermotherapy of circumscribed choroidal haemangioma. Eye. 2000;14(5):701–5.
Garcı́a-Arumı́ J, Sararols Ramsay L, Corcostegui Guraya B. Transpupillary thermotherapy for circumscribed choroidal hemangiomas. Ophthalmology. 2000;107(2):351–6.
Elizalde J, Vasquez L, Iyo F, Abengoechea S. Photodynamic therapy in the management of circumscribed choroidal hemangioma. Can J Ophthalmol. 2012;47(1):16–20.
Pilotto E, Urban F, Parrozzani R, Midena E. Standard versus bolus photodynamic therapy in circumscribed choroidal hemangioma: functional outcomes. Eur J Ophthalmol. 2011;21(4):452–8.
Scott TA, Augsburger JJ, Brady LW, Hernandez C, Woodleigh R. Low dose ocular irradiation for diffuse choroidal hemangiomas associated with bullous nonrhegmatogenous retinal detachment. Retina. 1991;11(4):389–93.
Alberti WE. Clinical features and management of choroidal hemangiomas, including those occurring in association with Sturge-Weber syndrome. In: Albert WE, Sagerman RH, editors. Radiotherapy of intraocular and orbital tumors. Berlin: Springer; 1993. p. 87–92.
Madreperla SA. Choroidal hemangioma treated with photodynamic therapy using verteporfin. Arch Ophthalmol. 2001;119(11):1606–10.
Landau IME, Steen B, Seregard S. Photodynamic therapy for circumscribed choroidal haemangioma. Acta Ophthalmol Scand. 2002;80(5):531–6.
Porrini G, Giovannini A, Amato G, Ioni A, Pantanetti M. Photodynamic therapy of circumscribed choroidal hemangioma. Ophthalmology. 2003;110(4):674–80.
Barbazetto I, Schmidt-Erfurth U. Photodynamic therapy of choroidal hemangioma: two case reports. Graefes Arch Clin Exp Ophthalmol. 2000;238(3):214–21.
Jurklies B, Anastassiou G, Ortmans S, Schüler A, Schilling H, Schmidt-Erfurth U, et al. Photodynamic therapy using verteporfin in circumscribed choroidal haemangioma. Br J Ophthalmol. 2003;87(1):84–9.
Schmidt-Erfurth UM, Michels S, Kusserow C, Jurklies B, Augustin AJ. Photodynamic therapy for symptomatic choroidal hemangioma: visual and anatomic results. Ophthalmology. 2002;109(12):2284–94.
Verbraak FD, Schlingemann RO, Keunen JEE, de Smet MD. Longstanding symptomatic choroidal hemangioma managed with limited PDT as initial or salvage therapy. Graefes Arch Clin Exp Ophthalmol. 2003;241(11):891–8.
Singh AD, Kaiser PK, Sears JE, Gupta M, Rundle PA, Rennie IG. Photodynamic therapy of circumscribed choroidal haemangioma. Br J Ophthalmol. 2004;88(11):1414–8.
Boixadera A, Arumí JG, Martínez-Castillo V, Encinas JL, Elizalde J, Blanco-Mateos G, et al. Prospective clinical trial evaluating the efficacy of photodynamic therapy for symptomatic circumscribed choroidal hemangioma. Ophthalmology. 2009;116(1):100–105.e1.
Singh AD. Ocular phototherapy. Eye. 2013;27(2):190–8.
Jurklies B, Bornfeld N. The role of photodynamic therapy in the treatment of symptomatic choroidal hemangioma. Graefes Arch Clin Exp Ophthalmol. 2005;243(5):393–6.
Schmidt-Erfurth UM, Kusserow C, Barbazetto IA, Laqua H. Benefits and complications of photodynamic therapy of papillary capillary hemangiomas. Ophthalmology. 2002;109(7):1256–66.
Xiao Y, Guo X, Ouyang P. Branch retinal artery occlusion associated with photodynamic therapy in a circumscribed choroidal haemangioma. Photodiagn Photodyn Ther. 2013;10(4):644–6.
Ritland JS, Eide N, Tausjø J. External beam irradiation therapy for choroidal haemangiomas. Visual and anatomical results after a dose of 20 to 25 Gy. Acta Ophthalmol Scand. 2001;79(2):184–6.
Karimi S, Nourinia R, Mashayekhi A. Circumscribed choroidal hemangioma. J Ophthalmic Vis Res. 2015;10(3):320–8.
Schilling H, Sauerwein W, Lommatzsch A, Friedrichs W, Brylak S, Bornfeld N, et al. Long term results after low dose ocular irradiation for choroidal haemangiomas. Br J Ophthalmol. 1997;81(4):267–73.
Zografos L, Egger E, Bercher L, Chamot L, Munkel G. Proton beam irradiation of choroidal hemangiomas. Am J Ophthalmol. 1998;126(2):261–8.
Hannouche D, Frau E, Desjardins L, Cassoux N, Habrand JL, Offret H. Efficacy of proton therapy in circumscribed choroidal hemangiomas associated with serious retinal detachment. Ophthalmology. 1997;104(11):1780–4.
Lee V, Hungerford JL. Proton beam therapy for posterior pole circumscribed choroidal haemangioma. Eye. 1998;12(6):925–8.
Zografos L, Bercher L, Chamot L, Gailloud C, Raimondi S, Egger E. Cobalt-60 treatment of choroidal hemangiomas. Am J Ophthalmol. 1996;121(2):190–9.
Lopez-Caballero C, Saornil MA, De Frutos J, Bianciotto C, Muiños Y, Almaraz A, et al. High-dose iodine-125 episcleral brachytherapy for circumscribed choroidal haemangioma. Br J Ophthalmol. 2010;94(4):470–3.
Aizman A, Finger PT, Shabto U, Szechter A, Berson A. Palladium 103 (103Pd) plaque radiation therapy for CircumscribedChoroidal hemangioma with retinal detachment. Arch Ophthalmol. 2004;122(11):1652–6.
Mandal S, Naithani P, Venkatesh P, Garg S. Intravitreal bevacizumab (avastin) for circumscribed choroidal hemangioma. Indian J Ophthalmol. 2011;59(3):248–51.
Sagong M, Lee J, Chang W. Application of intravitreal bevacizumab for circumscribed choroidal hemangioma. Korean J Ophthalmol. 2009;23(2):127–31.
Sanz-Marco E, Gallego R, Diaz-Llopis M. Oral propranolol for circumscribed choroidal hemangioma. Case Rep Ophthalmol. 2011;2(1):84–90.
Tanabe H, Sahashi K, Kitano T, Tomita Y, Saito AM, Hirose H. Effects of oral propranolol on circumscribed choroidal hemangioma: a pilot study. JAMA Ophthalmol. 2013;131(12):1617–22.
Sullivan TJ, Clarke MP, Morin JD. The ocular manifestations of the Sturge-Weber syndrome. J Pediatr Ophthalmol Strabismus. 1992;29(6):349–56.
Susac JO, Smith JL, Scelfo RJ. The tomato-catsup fundus in Sturge-Weber syndrome. Arch Ophthalmol. 1974;92(1):69–70.
Shanmugam PM, Ramanjulu R. Vascular tumors of the choroid and retina. Indian J Ophthalmol. 2015;63(2):133–40.
Abdolrahimzadeh S, Scavella V, Felli L, Cruciani F, Contestabile MT, Recupero SM. Ophthalmic alterations in the Sturge-Weber syndrome, Klippel-Trenaunay syndrome, and the Phakomatosis Pigmentovascularis: an independent group of conditions? Biomed Res Int. 2015;2015:1–11.
Hussain RN, Jmor F, Damato B, Heimann H. Verteporfin photodynamic therapy for the treatment of choroidal haemangioma associated with Sturge-Weber syndrome. Photodiagn Photodyn Ther. 2016;15(Supplement C):143–6.
Grant LW, Anderson C, Macklis RM, Singh AD. Low dose irradiation for diffuse choroidal hemangioma. Ophthalmic Genet. 2008;29(4):186–8.
Gottlieb JL, Murray TG, Gass JDM. Low-dose external beam irradiation for bilateral diffuse choroidal hemangioma. Arch Ophthalmol. 1998;116(6):815–7.
Yonekawa Y, MacDonald SM, Shildkrot Y, Mukai S. Standard fractionation low-dose proton radiotherapy for diffuse choroidal hemangiomas in pediatric Sturge-Weber syndrome. J Am Assoc Pediatr Ophthalmol Strabismus. 2013;17(3):318–22.
Murthy R, Hanovar S, Naik M, Gopi S, Reddy VA. Ruthenium-106 plaque brachytherapy for the treatment of diffuse choroidal haemangioma in Sturge-Weber syndrome. Indian J Ophthalmol. 2005;73:274–5.
Arepalli S, Shields CL, Kaliki S, Emrich J, Komarnicky L, Shields JA. Diffuse choroidal hemangioma management with plaque radiotherapy in 5 cases. Ophthalmology. 2013;120(11):2358–9.
Tsipursky MS, Golchet PR, Jampol LM. Photodynamic therapy of choroidal hemangioma in Sturge-Weber syndrome, with a review of treatments for diffuse and circumscribed choroidal hemangiomas. Surv Ophthalmol. 2011;56(1):68–85.
Monteiro S, Casal I, Santos M, Meireles A. Photodynamic therapy for diffuse choroidal hemangioma in Sturge-Weber syndrome [internet]. Case Rep Med. 2014;2014:452372. https://www.hindawi.com/journals/crim/2014/452372/abs/
Anand R. Photodynamic therapy for diffuse choroidal hemangioma associated with Sturge weber syndrome. Am J Ophthalmol. 2003;136(4):758–60.
Cacciamani A, Scarinci F, Parravano M, Giorno P, Varano M. Choroidal thickness changes with photodynamic therapy for a diffuse choroidal hemangioma in Sturge-Weber syndrome. Int Ophthalmol. 2014;34(5):1131–5.
Singh AD, Rundle PA, Vardy SJ, Rennie IG. Photodynamic therapy of choroidal haemangioma associated with Sturge-Weber syndrome. Eye (Lond). 2005;19(3):365–7.
Shoeibi N, Ahmadieh H, Abrishami M, Poorzand H. Rapid and sustained resolution of serous retinal detachment in Sturge-Weber syndrome after single injection of intravitreal bevacizumab. Ocul Immunol Inflamm. 2011;19(5):358–60.
Paulus Y, Jain A, M Moshfeghi D. Resolution of persistent exudative retinal detachment in a case of Sturge-Weber syndrome with anti-VEGF administration. Ocul Immunol Inflamm. 2009;17:292–4.
Arevalo JF, Arias JD, Serrano MA. Oral propranolol for exudative retinal detachment in diffuse choroidal hemangioma. Arch Ophthalmol. 2011;129(10):1373–5.
Mandal AK. Primary combined trabeculotomy-trabeculectomy for early-onset glaucoma in Sturge-Weber syndrome. Ophthalmology. 1999;106(8):1621–7.
Addison PKF, Papadopoulos M, Nischal KK, Hykin PG. Serous retinal detachment induced by topical bimatoprost in a patient with Sturge–Weber syndrome. Eye. 2011;25(1):124–5.
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Gupta, S., Kaliki, S. (2020). Choroidal Hemangioma and Its Management. In: Khetan, V. (eds) Intraocular Tumors. Springer, Singapore. https://doi.org/10.1007/978-981-15-0395-5_12
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