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PHOTO ESSAY
Year : 2017  |  Volume : 29  |  Issue : 3  |  Page : 250-251

Cavernous hemangioma


Department of Ophthalmology, Jyothis Eye Care Hospital, Kannur, Kerala, India

Date of Web Publication30-Jan-2018

Correspondence Address:
Dr. Sharmil Gopal
Jyothis Eye Care Hospital, Pallikunnu, Kannur - 670 004, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_108_17

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How to cite this article:
Gopal S, Nataraj A, Vinod S, Jaison V A. Cavernous hemangioma. Kerala J Ophthalmol 2017;29:250-1

How to cite this URL:
Gopal S, Nataraj A, Vinod S, Jaison V A. Cavernous hemangioma. Kerala J Ophthalmol [serial online] 2017 [cited 2018 May 25];29:250-1. Available from: http://www.kjophthal.com/text.asp?2017/29/3/250/224287



A 14-year-old boy presented to us for regular checkup. His best-corrected visual acuity was normal in both the eyes. Anterior segment examination was normal. Intraocular pressure was within the normal limits. Fundus examination in the right eye showed hard exudates in the macula and telangiectatic venules along the superotemporal vascular arcade [Figure 1]. The left eye fundus was normal [Figure 2].
Figure 1: Fundus picture of the right eye showing cavernous hemangioma along superotemporal arcade

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Figure 2: Fundus picture of the left eye

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Fundus fluorescein angiography of the right eye showed slow fluorescein appearance in the early- and midphase and a characteristic fluorescein erythrocyte interface in the late phase [Figure 3], [Figure 4]. There was absence of leakage. The left eye was normal.
Figure 3: Arteriovenous phase showing filling of dye in cavernous hemangioma with absence of leakage

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Figure 4: Late phase showing characteristic fluorescein erythrocyte interphase with absence of leakage

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Optical coherence tomography (OCT) of the right eye showed intraretinal hyperreflective echoes suggestive of hard exudates along with minimal macular thickening away from the fovea [Figure 5]a. The left eye OCT was normal [Figure 5]b.
Figure 5: Optical coherence tomography macula of the right eye showing minimal thickening close to fovea. (a) right, (b) left

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A general systemic examination was done including magnetic resonance imaging of head which was normal.

The patient was diagnosed to have cavernous hemangioma in the right eye. Only atypical finding was the presence of hard exudates in the macula.


  Discussion Top


Cavernous hemangioma is usually a benign, unilateral, nonprogressive vascular tumor of retina. It affects children and young adults. It is usually isolated, sporadic, or familial autosomal dominant with incomplete penetrance which is associated with cerebral cavernous malformations and similar skin and central nervous system lesions (phakomatoses).[1] Familial form is associated with three genes: CCM 1, CCM 2, and CCM 3. CCM 3 has the high risk of cerebral hemorrhage.

Clinically, it appears as a cluster of intraretinal dark red blood-filled saccules simulating a bunch of grapes. The usual site is along the course of retinal vein along superotemporal arcade and sometimes optic disc. The lesion does not have a feeding artery and exudation is very rare. An overlying white fibroglial tissue is sometimes seen on the tumor surface.[1]

It is usually asymptomatic and rarely visual impairment occurs due to vitreous hemorrhage, secondary retinal traction, or macular scarring. Cranial nerve palsies or stroke occurs if associated with cerebral hemangioma bleed and raised intracranial tension.[1] No treatment is required for this lesion. If vitreous hemorrhage occurs, vitrectomy, cryotherapy, photocoagulation, and low-energy plaque therapy may be used to treat these tumors.[1]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shanmugam PM, Ramanjulu R. Vascular tumors of the choroid and retina. Indian J Ophthalmol 2015;63:133-40.  Back to cited text no. 1
[PUBMED]  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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