38 RETINA TODAY | NOVEMBER/DECEMBER 2016 OCULAR ONCOLOGY Complete tumor regression and complete resolution of total retinal detachment were achieved in this case of a boy with Sturge-Weber syndrome. BY LARA QUEIRÓS, MD; KAREEM SIOUFI, MD; AND CAROL L. SHIELDS, MD DIFFUSE CHOROIDAL HEMANGIOMA TREATED WITH LOW-DOSE PLAQUE BRACHYTHERAPY Choroidal hemangio- ma is a vascular ham- artoma that generally manifests in young to middle-aged adults with painless blurred vision. Visual acuity loss is due to one or a combination of several findings, including subretinal fluid (SRF) leakage, intraretinal edema, tumor-induced hyperopia, and long- standing amblyopia related to macular location of the tumor. 1 Based on the extent of choroidal hemangioma, this lesion is classified as either circumscribed (localized) or diffuse (involv- ing a major portion of the fundus). The circumscribed form is sporadic, is usually located in the macular or perimacular region, and generally measures about 6 mm in basal dimen- sion and 3 mm in thickness. 2 The circumscribed form is most often controlled with photodynamic therapy (PDT). 1 Diffuse choroidal hemangioma (DCH) is usually seen as a manifestation of Sturge-Weber syndrome, in association with venous angioma/telangiectasia involving the facial skin (port wine stain) and leptomeninges. 1 Less commonly, ocular mani- festations include vascular anomalies in the conjunctiva, epi- sclera, and retina as “twin vessels.” Glaucoma can be a major finding of Sturge-Weber syndrome. 1 Management of DCH is challenging because of the varied findings. Here we present a case of DCH with total exudative retinal detachment (RD) treated with low-dose iodine-125 (I-125) plaque radiotherapy. CASE REPORT A 6-year-old boy with known Sturge-Weber syndrome noted a gradual decrease in vision in his left eye (OS). He had a history of anisometropic hyperopia with refractive amblyopia OS, with previous baseline BCVA of 20/80 in both eyes (OU) at age 5 years. As an infant he underwent treatment of cuta- neous port wine stain with a dermatologic tunable dye laser. On our examination, there was a mild residual port wine stain involving the left malar region and 10 prism diopters of left esotropia (Figure 1). Ocular motility was full OU. BCVA was 20/20 in the right eye (OD) and hand motions OS. Intraocular pressures were within normal limits OU. The right eye was unre- markable. The left eye showed minimally dilated superior con- junctival vessels with no other anterior segment abnormalities. The fundus OS disclosed total RD overlying a barely perceptible DCH that was more prominent inferiorly (Figure 2A and 2B). • Choroidal hemangioma is a vascular hamartoma that generally manifests in young to middle-aged adults with painless blurred vision. It is classified as either circumscribed or diffuse choroidal hemangioma (DCH). • Although photodynamic therapy is the preferred treatment for circumscribed choroidal hemangioma, it is not often used for DCH because patients are young and potentially uncooperative. • Plaque brachytherapy can deliver a precise and localized dose of radiotherapy to a selected field with minimal damage to surrounding tissues. AT A GLANCE