Beyond Treatment - The Strategy of Nonintervention in Choroidal Hemangioma

Sep 29, 2026

Circumscribed choroidal hemangioma (CCH) is a benign congenital eye tumor with unclear etiology. A 41-year-old woman presented with a 2-year history of slowly worsening vision in the right eye, while the left eye maintained good vision. Imaging showed yellow macular lesion with serous retinal detachment, choroidal high-reflectivity vascular lesion on B-scan and Doppler, and a massive choroidal mass obscured on OCT. Despite angiographic early vascularity and late hyperfluorescence, observation was selected instead of TTT, radiotherapy, or verteporfin PDT due to proximity to the macula, poor baseline acuity, and limited PDT availability.

LanguageEnglish

CategoryHealthcare

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Pages6

Reading Time15 min

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ABSTRACT

1 | Introduction

Differential diagnoses and complications

Imaging and diagnostic relevance

Key Clinical Message

Clinical Case Reports CASE REPORT OPEN ACCESS Beyond Treatment: The Strategy of Nonintervention in Choroidal Hemangioma Humdan Khan1 | Muhammad Shaheer Bin Faheem2 | Hurmat Fatima3 | Asfandyar Asghar4 | Ahmed Ali Khan5 | Muhammad Rehan Zahid3 | Syed Tawassul Hassan6 | Izzah Shakkel7 | Muhammad Idrees Khan8 1Department of Internal Medicine, University of Sheffield, Sheffield, South Yorkshire, UK | 2Department of Medicine and Surgery, Karachi Institute of Medical Sciences, KIMS, Karachi, Sindh, Pakistan | 3Department of Internal Medicine, Foundation University Medical College, Islamabad, Pakistan | 4Department of Internal Medicine, Fauji Foundation Hospital, Rawalpindi, Pakistan | 5Department of Internal Medicine, Sialkot Medical College, Sialkot, Pakistan | 6Department of Internal Medicine, Karachi Medical and Dental College, KMDC, Karachi, Sindh, Pakistan | 7Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan | 8Department of Internal Medicine, Adam University School of Medicine, Bishkek, Kyrgyzstan Correspondence: Muhammad Idrees Khan ([dridrees666@gmail.com](dridrees666@gmail.com)) Received: 12 August 2025 | Revised: 9 December 2025 | Accepted: 19 December 2025 Keywords: choroidal hemangioma | multimodal imaging | nonintervention | ocular tumors | resource-limited settings | serous retinal detachment ABSTRACT The circumscribed choroidal hemangioma (CCH) is a benign congenital eye tumor whose etiology is not clear. A 41-year-old female patient came with a 2-year history of slowly progressive deteriorating vision in her right eye. In the left eye, the bestcorrected visual acuity (BCVA) was 6/6, and counting fingers at 1 m in the right eye. The wide-field fundus showed a yellow macular lesion with indistinct limits, which is a sign of serous retinal detachment. B-scan ultrasonography revealed a clear-cut choroidal lesion, high internal reflectivity, and visible intrinsic vascularity on color Doppler. OCT has shown a massive choroidal mass with damaged RPE and outer retinal layers, which has been obscured by serous retinal detachment. The chest x-ray revealed bronchiectatic opacities, the CT scan revealed no lung lesions, and LFTs and RFTs were normal. The fluorescein angiography revealed a choroidal hemangioma with early vascularity and late hyperfluorescence. Nonetheless, the retinal team chose the option of observation instead of TTT, radiotherapy, or verteporfin photodynamic therapy due to the closeness of the lesion to the macula, low visual acuity, and lack of verteporfin PDT in Pakistan. To sum up, the present case demonstrates the significance of multimodal imaging in the proper diagnosis of choroidal hemangiomas and the necessity to pay close attention to patient-specific factors when making treatment decisions, especially in limited resource settings. 1 | Introduction Circumscribed choroidal hemangioma (CCH) is a benign and congenital tumor of the eye that has an unclear pathogenesis. It is normally classified into specific, circumscribed, and diffuse. The circumscribed variant is often solitary and is likely to be independent of the systemic ailments. The diffuse type, on the other hand, is associated with Sturge–Weber syndrome, which is a rare neurocutaneous condition that has port-wine stains and choroidal lesions [1] . The majority of patients exhibiting CCH start showing symptoms and seeking medical attention in adulthood, which is usually between the fourth and sixth decades of their lives [2] . It is usually sporadic, and there is a slight male predisposition [3] . The exact incidence of CCH is not known, with only the cases that are symptomatic or accidentally diagnosed being reported. Nevertheless, it is estimated that every fifteen cases of choroidal melanoma have one case of CCH [4] . CCH is usually a red-orange lesion in the posterior pole. The signs of CCH are mild, and it is not uncommon to find a This is an open access article under the terms o

FAQs

What is circumscribed choroidal hemangioma (CCH) and why is it significant?

CCH is a benign congenital eye tumor with unclear pathogenesis. Timely diagnosis is important to prevent irreversible visual impairment.

What did multimodal imaging reveal in the case?

Wide-field fundus showed a yellow macular lesion with indistinct margins consistent with serous retinal detachment. B-scan and color Doppler demonstrated a choroidal lesion with high internal reflectivity and intrinsic vascularity, while OCT showed a massive choroidal mass with damaged RPE and outer retinal layers obscured by detachment.

Why was nonintervention (observation) chosen instead of active treatments?

Observation was selected rather than TTT, radiotherapy, or verteporfin photodynamic therapy because the lesion was close to the macula, baseline visual acuity was low, and verteporfin PDT was not available in Pakistan.

Sep 29, 2026

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