Circumscribed choroidal haemangioma: clinical and topographical features

Abstract

Aims: To characterise the clinical and topographical features of circumscribed choroidal haemangioma (CCH) and to visualise the patterns of tumour extent in the ocular fundus.

Methods: Data on the size, shape and location of 113 CCH were converted into a database of two-dimensional retinal charts by means of computer drawing software. The extent of the tumours was visualised by merging the charts and displaying the number of overlapping tumours on colour-coded maps.

Results: The mean largest tumour diameter was 7.2 mm (range, 2.5-11.0 mm), mean tumour height was 2.4 mm (range, 0.7-4.6 mm) and mean diameter/height ratio was 3.2 (range, 2.1-6.0). The mean distance from the posterior tumour margin to the foveola and optic disc margin was 1.7 mm (range, 0-15 mm) and 2.4 mm (range, 0-11 mm), respectively. The hemispheric location of the tumour centroid was temporal in 75 eyes (66%) and nasal in 38 (34%) (p=0.0005) and the distribution between the superior and inferior hemispheres was 68 (60%) and 45 (40%), respectively (p=0.03). The presence of subretinal fluid (SRF) was significantly associated with young age at diagnosis (p=0.0002), low tumour diameter/height ratio (p=0.0004), nasal hemisphere location (p=0.006) and close proximity to the optic disc (p=0.004).

Conclusions: The superotemporal quadrant close to the macula is the most frequent location of CCH. The tumours are generally characterised by a diameter/height ratio of >2. Tumours in young patients, with marked elevation, in nasal hemisphere and in proximity to the optic disc are associated with SRF exudation.

Keywords: circumscribed choroidal haemangioma; distribution; imaging; location; topography.

Figure 1

(A,B) Images of the left eye of a 63-year-old man showing two distinct circumscribed choroidal haemangiomas: one superior to the optic disc and one along the inferotemporal vascular arcade. (A) Multicolour scanning laser image (composite). (B) Ultra-widefield indocyanine green angiogram (40 s after injection).

Figure 2

Merged fundus drawings showing the location of 113 CCH on a retinal chart with a foveal centre surrounded by circles representing the equator, ora serrata and limbus. The colours on the chart indicate the number of overlapping CCH according to the colour scale bar to the right. The top of the scale (dark red) represents the maximum number of overlapping tumours (47) and the bottom (dark blue) indicates no tumours. CCH, circumscribed choroidal haemangiomas.

Figure 3

(A–F) Merged fundus drawings of circumscribed choroidal haemangiomas showing the patterns of tumour extent according to various patient and tumour characteristics. The retinal chart and colour scale details are as described in figure 2. Note that the maximum number of overlapping tumours differs between the images. The following numbers in parentheses refer to the maximum number of overlapping tumours: (A) tumours with subretinal fluid exudation (28), (B) tumours without subretinal fluid exudation (20), (C) age <58 years (24), (D) age ≥58 years (26), (E) tumour diameter/height-ratio<3 (21), (F) tumour diameter/height-ratio≥3 (28).

Figure 4

Scatter plot showing the distribution of the basal diameter/height ratio for 110 posterior UM previously reported by Krohn et al and for the 113 CCH in the present study. The basal diameter/height ratio for each UM and CCH are represented by blue diamonds and red squares, respectively. A small number of the plotted points have been slightly jittered to avoid overlap. Note that all the CCH have a basal diameter/height ratio above 2 (indicated by the dashed horizontal line). CCH, circumscribed choroidal haemangiomas; UM, uveal melanomas.