A O Saatci, U Gunenc, M Tunc, G Cingil.
Successful Laser Therapy of Choroidal Hemangioma with Bullous Retinal Detachment.
Pak J Ophthalmol Jan ;11(1):11-4.

Choroidal hemangiomas may cause visual loss by a direct involvement of the macula or by an associated retinal detachment. Differential diagnosis can be a major problem, and ultrasonography is the key diagnostic tool. Photocoagulation is the mainstay of treatment, and is indicated only when there also is a concurrent retinal detachment. We successfully treated by argon green laser photocoagulation a choroidal hemangioma with associated bullous inferior retinal detachment in the left eye of a 48-year-old woman.

Case Report: A 48-year-old otherwise healthy woman had a complaint of decreased vision in her left eye for eight weeks. She was told of having a choroidal malignant melanoma at another institution. She sought a second opinion. Her past ocular, medical, and family histories were unremarkable. On eye examination, visual acuity was 20/20 in her right eye and perception of hand movements in the left. Applanation intraocular pressure was 15 mm Hg in each eye. The external and slit lamp examinations were normal. Funduscopic examination of the right eye was normal, but there was a discrete, slightly elevated, orange-colored mass in the upper temporal fundus under the superior temporal vessels. It was six-optic disc diameter in size. There was an inferior bullous retinal detachment beginning near the inferior temporal vessels. Fluorescein angiography showed an early and progressively diffuse leakage. A-scan ultrasonography revealed a 4.2 mm thick choroidal mass with high internal reflectivity, and B-scan ultrasonography showed a raised, solid lesion with a bullous retinal detachment. No acoustic choroidal excavation and orbital shadowing were noticed. MRI of the eye did not yield any positive diagnostic clue. There were no pertinent laboratory data and systemic findings. Thus, we diagnosed the mass as a choroidal hemangioma and treated the lesion with argon green laser photocoagulation in two four-week apart sessions. The laser applications in each session were made over the whole surface of the tumor. In the first session, a total of 373 confluent laser applications of 300 um size at 300 mW power for 0.2 to 0.5 second durations were made. At the second session, a total of 186 similar laser applications were carried out. Three months later, though there was no increase in the visual acuity of the eye, a total resolution of the bullous retinal detachment was noted. The fluorescein fundus angiography demonstrated partial obliteration of the hemangioma.

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