Circumscribed choroidal hemangioma - Clinical manifestations and factors predictive of visual outcome in 200 consecutive cases

Purpose: To review the clinical features and management of circumscribed ch oroidal hemangioma and determine factors predictive of poor visual outcome. Design: Retrospective consecutive noncomparative interventional case series . Participants: Two hundred consecutive patients with circumscribed choroidal hemangioma. Main Outcome Measures: The main outcome measures were analyzed in 155 patie nts with follow-up of at least 3 months and included complete resolution of subretinal fluid, worsening of visual acuity (more than 2 Snellen lines), and poor final visual acuity (20/200 or worse). Results: The patients were seen at a mean age of 45 years with symptoms of decreased visual acuity (81%) visual field defect (7%), metamorphopsia (3%) , floaters (2%), progressive hypermetropia (1%), photopsia (1%) pain (1%), and no symptoms (6%). The referring diagnoses were choroidal hemangioma (29 %), choroidal melanoma (29%), choroidal metastasis (9%), retinal detachment (6%), central serous chorioretinopathy (5%), and others. The tumor had a m edian base of 6.0 mm and median thickness of 3.0 mm. Secondary retinal deta chment in the foveal region was present in 81% of the patients. Initial tre atment included observation (51%), laser photocoagulation (44%), plaque rad iotherapy (4%), external beam radiotherapy (1%), surgical repair of retinal detachment (1%), and enucleation for painful neovascular glaucoma (1%). Ka plan-Meier estimates revealed complete resolution of subretinal fluid in 60 % patients at 5 years and 76% patients at 10 years follow-up. By multivaria ble analysis, clinical factors predictive of complete resolution of subreti nal fluid included shorter duration of symptoms (P = 0.03) and inferior qua drant location of tumor (P = 0.001). At initial presentation, 82 of 155 (53 %) patients had poor visual acuity (20/200 or worse), and 73 of 155 (47%) p atients had good to moderate visual acuity (20/100 or better). Of those 82 patients with poor initial vision, poor final vision was found in 54% at 5 years and 80% at 10 years. Of the 73 patients with good to moderate initial vision, poor final vision was found in 12% at 5 years and 43% at 10 years. By multivariable analysis, clinical factors predictive of poor final visua l acuity included poor initial visual acuity (P < 0.001), failure of previo us laser photocoagulation before referral (P = 0.01), and tumor management with observation after referral (P = 0.02). Worsening of visual acuity (by more than 2 Snellen lines) was observed in 8% at 5 years and 28% at 10 year s of those 82 patients who were initially seen with poor vision. Worsening of visual acuity was found in 10% at 5 years and 30% at 10 years of those 7 3 patients who initially were seen with good to moderate vision. Conclusions: Circumscribed choroidal hemangioma is a rare intraocular tumor . In 38% of cases, this tumor is initially misinterpreted before referral a s choroidal melanoma or metastasis. Visual acuity is poor in more than 60% of patients at 10 years, despite successful control of associated subretina l fluid in 76% patients. (C) 2001 by the American Academy of Ophthalmology.