Management of Choroidal Hemangioma

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.