Over time, the hemangiomamay cause a degenerative breakdown of the overlying RPE, resulting in cysticedema or a serous detachment of the sensory retina. Fluorescein angiography shows a characteristic pattern of early hyperfluorescencecorresponding to the large vascular channels in the tumor. Later in theangiogram there is widespread fluorescence secondary to diffuse leakageof the dye from the surface of the tumor. A circular zone of hypofluorescencecorresponding to the edges of the tumor also appears in the early and middlephases of the angiogram. Finally, the fluorescein pattern will show characteristicpolycystic degenerative changes and overlying retinal edema.
Problem is, a similar staining pattern shows up in other similar-sizedtumors.
That s why ultrasonography is the most helpful test in differentiatingthese tumors from more serious conditions such as choroidal melanoma. Achoroidal melanoma shows low to medium reflectivity, whereas a choroidalhemangioma demonstrates high reflectivity. Most of all, it s the reddish-orangecolor of the lesion on BIO that helps differentiate a choroidal hemangiomafrom other light or nonpigmented lesions. Patients don t require treatment unless they develop cystoid macularedema or an exudative neurosensory detachment involving the macula. Thesecases call for photocoagulation to the surface of the tumor, hoping tocollapse the cystic retina onto the tumor with subsequent resolution ofthe subretinal fluid.