Combined Approach for Management of a Case of Peripapillary Choroidal Hemangioma

Abstract

Circumscribed choroidal hemangioma (CCH) is a rare vascular benign tumour of the choroid that typically presents as a solitary red-orange mass within the posterior pole in middle-aged adults with clinical symptoms of progressive vision loss, floaters, metamorphopsia and field defects. Despite its benign nature, it can present with complications, including subretinal fluid (SRF), serous detachment, cystoid macular oedema, and, in chronic cases, retinoschisis, retinal pigment epithelium changes, and neovascular glaucoma. Choroidal metastasis and choroidal melanoma have a close resemblance to choroidal haemangioma, which leads to a diagnostic dilemma. Imaging tools such as ultrasonography, optical coherence tomography, optical coherence tomography angiography, fluorescein angiography and indocyanine green angiography aid in the diagnosis making. Treatment aims to decrease exudation and thereby improve visual acuity in symptomatic patients. Photocoagulation, radiation therapy, photodynamic therapy (PDT), transpupillary thermotherapy (TTT), oral beta blockers and anti-vascular endothelial growth factor (VEGF) therapy are the available treatment options. In our case, we report a patient of circumscribed peripapillary choroidal hemangioma managed with a combined approach-based treatment using intravitreal anti-VEGF and oral beta blocker therapy. Due to its close proximity to the optic nerve of CCH, its treatment poses a challenge. Our case illustrates how a combined approach facilitates the successful management of the lesion.