IP International Journal of Ocular Oncology and Oculoplasty 2020;6(1):76–78 Content available at: iponlinejournal.com IP International Journal of Ocular Oncology and Oculoplasty Journal homepage: www.innovativepublication.com Case Report A classical case of cavernous hemangioma of the retina T Premsai 1 , Renuka Srinivasan 1 , Hannah Ranjee Prasanth 1, *, Manoj Khatri 1 , Ishwarya T.S 1 1 Dept. of Ophthalmology, Pondicherry Institute of Medical Sciences, Pondicherry, India ARTICLE INFO Article history: Received 11-01-2020 Accepted 12-02-2020 Available online 24-04-2020 Keywords: Retinal cavernous hemangioma vision loss cluster of grapes vision loss Cluster of grapes Saccular aneurysm ABSTRACT Cavernous hemangioma is a vascular hamartoma, composed of clusters of intraretinal aneurysms. It is usually unilateral, asymptomatic and rarely increase in size. Visual symptoms may occur due to macular involvement or vitreous hemorrhage. © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by/4.0/) 1. Case Report A 12-year-old female presented with gradually progressive, painless diminution of vision in her left eye for 1 year. On examination best corrected visual acuity in her right eye was 6/6 and left eye was 6/36. Her anterior segment examination was unremarkable. Left eye fundus examination - normal disc and vessels. At 3 DD temporal to disc, saccular grape like clusters of thin-walled angiomatous lesions was seen in the parafoveal region extending upto the ora serrata. (Figure 1) Periphery of the lesion showed chorioretinal atrophy that spilled on to the macula. (Figure 2). There was fibrous tissue at the periphery of the lesion near ora serrata (Figure 3). A clinical diagnosis of left eye cavernous hemangioma was made. A-Scan showed a high initial spike with high internal reflectivity. B-Scan showed an irregular elevated hyperechoic lesion with no choroidal excavation. OCT Macula revealed thickening, multiple saccules with bridges in between them (Figure 4). Systemic examination by a pediatrician was * Corresponding author. E-mail address: drranjee@hotmail.com (H. R. Prasanth). normal and MRA Brain was normal study. 2. Discussion A hamartoma is a benign lesion consisting of normal tissues in an abnormal configuration. Cavernous hemangioma of the retina is a vascular hamartoma. It usually arises in the second decade of life and is more common in females. 1 Most cases of cavernous hemangiomas are sporadic, but they have been classified as part of Phakomatosis, which are multisystem disorders characterized by development of hamartomatous lesions involving CNS, skin and visceral organs in the body. Cavernous hemangiomas are saccular aneurysms which are filled with venous blood. They mainly present between the 3 to 5 th decade of life 2 (2) and account for 5 to 13% of vascular malformations. 3 Typically the tumour is around 1- 2 disc diameters in size and resemble “a bunch of grapes”. It may be an isolated lesion or it can fill the entire fundus. It may even follow the course of a major blood vessel. The lesion becomes symptomatic when it causes vitreous hemorrhage or when it is located on or next to the macula https://doi.org/10.18231/j.ijooo.2020.015 2581-5024/© 2020 Innovative Publication, All rights reserved. 76