Nguyen A T, Anderson S F, Townsend J C
J Am Optom Assoc. 1995 Oct;66(10):640-5.
Circumscribed or solitary choroidal hemangioma is a relatively rare, benign vascular tumor. Because its appearance may mimic more serious intraocular lesions, eye care practitioners should be familiar with differential diagnosis and treatment options.
A patient presented with an asymptomatic, elevated, red-orange lesion above the macula in the right eye and a history of longstanding unexplained visual acuity loss in the eye. Intraocular lesions such as amelanotic melanoma, metastatic tumor, choroidal osteoma, disciform scar, serous detachment, and central serous chorioretinopathy can appear similar to circumscribed choroidal hemangioma (CCH) on ophthalmoscopy, but may be differentially diagnosed with fluorescein angiography, ultrasonography, and periodic observation.
CCH requires various therapeutic options. Until the patient becomes symptomatic from visual loss secondary to serous macular detachment or subretinal neovascular membrane formation, no treatment is necessary. Laser photocoagulation is the preferred therapeutic intervention, and most patients will require a minimum of two sessions. A small percentage of individuals will progress to complete retinal detachment with profound visual loss regardless of therapy. Most CCHs remain stable in size and do not undergo malignant transformation.
CCHs may be overlooked because of their initial subtle clinical appearance with no associated cutaneous or systemic anomaly. Even though CCH is a benign tumor, it may mimic more serious intraocular lesions and require a combination of ancillary tests for proper diagnosis. Depending on visual symptoms or potential threat to vision, management options include periodic observation, laser photocoagulation, cryotherapy, microwave therapy, and possible enucleation. CCH has little or no growth potential, but visual prognosis remains guarded due to significant secondary retinal changes that can occur over the tumor's surface. CCH must be considered in the differential diagnosis of an elevated intraocular lesion.
局限性或孤立性脉络膜血管瘤是一种相对罕见的良性血管肿瘤。由于其外观可能类似于更严重的眼内病变，眼科医生应熟悉其鉴别诊断和治疗方案。
一名患者右眼黄斑上方出现无症状、隆起的红橙色病变，且该眼有长期不明原因视力丧失的病史。眼内病变如无色素性黑色素瘤、转移瘤、脉络膜骨瘤、盘状瘢痕、浆液性脱离和中心性浆液性脉络膜视网膜病变在检眼镜检查时可能与局限性脉络膜血管瘤（CCH）相似，但可通过荧光素血管造影、超声检查和定期观察进行鉴别诊断。
CCH需要多种治疗方案。在患者因浆液性黄斑脱离或视网膜下新生血管膜形成导致视力丧失而出现症状之前，无需治疗。激光光凝是首选的治疗干预措施，大多数患者至少需要进行两次治疗。无论采用何种治疗方法，一小部分患者会进展为完全性视网膜脱离并伴有严重视力丧失。大多数CCH的大小保持稳定，不会发生恶变。
CCH最初的临床表现可能很细微，且无相关皮肤或全身异常，因此可能被忽视。尽管CCH是一种良性肿瘤，但它可能类似于更严重的眼内病变，需要结合辅助检查才能做出正确诊断。根据视觉症状或对视力的潜在威胁，治疗方案包括定期观察、激光光凝、冷冻疗法、微波治疗以及可能的眼球摘除术。CCH的生长潜力很小或没有，但由于肿瘤表面可能发生明显的继发性视网膜改变，视力预后仍不容乐观。在鉴别诊断眼内隆起病变时必须考虑CCH。
Zotero 插件