Changing concepts in management of circumscribed choroidal hemangioma: The 2003 J. Howard Stokes Lecture, part 1

BACKGROUND AND OBJECTIVE: To review trends in the management of circumscribed choroidal hemangioma (CCH) and to propose treatment guidelines based on review of recent literature and the authors' personal experience with more than 250 cases. METHOD: The English-language literature on the management of CCH was reviewed, with emphasis on changing concepts in recent years. RESULTS: Xenon arc and argon laser photocoagulation and thermotherapy have been used to treat CCH with localized retinal detachment, but there has recently been enthusiasm for photodynamic therapy (PDT) using fluorescein angiography and optical coherence tomography to monitor subretinal fluid and cystoid retinal edema before and after treatment. Tumors with extensive retinal detachment have been managed by surgical attempts at retinal reattachment followed by photocoagulation or cryotherapy, and more recently by radiotherapy. Management currently includes observation, argon laser photocoagulation, transpupillary thermotherapy, PDT, and radiotherapy. Enucleation may be necessary in rare cases. The goal of treatment should be to induce resolution of existing retinal detachment and to improve or stabilize visual loss. CONCLUSIONS: There is increasing use of PDT for CCH with localized retinal detachment and radiotherapy for CCH with more extensive detachment. Although follow-up is short, current methods may achieve better tumor control and better visual outcome. However, caution is advised because long-term follow-up is still not available.

Duke Scholars

Author Miguel Angel Materin Ophthalmology, Vitreoretinal Diseases & Surgery