Circumscribed choroidal hemangioma presenting with acute metamorphopsia and exudative maculopathy: A case report

Background: Circumscribed Choroidal Hemangioma (CCH) is a benign vascular hamartoma of the choroid that may be detected in adulthood when exudation causes subretinal fluid and macular edema. Because it can clinically mimic amelanotic choroidal melanoma and other choroidal masses, multimodal imaging is essential for accurate diagnosis and to guide treatment.

Case presentation: A 30-year-old man presented with 5 days of decreased vision and metamorphopsia in the right eye. Best-corrected Visual Acuity (VA) was 6/24 in the right eye (no improvement with pinhole) and 6/6 in the left eye; intraocular pressure (IOP) was 12 mmHg in both eyes. Anterior segment examination was unremarkable bilaterally. Fundus examination of the right eye showed macular edema and a circumscribed reddish-orange, elevated choroidal lesion located nasal to the optic disc, approximately 3×5 disc diameters in size, with mild blurring/elevation of the nasal disc margin and no associated hemorrhage; the left fundus was normal. Amsler grid testing demonstrated metamorphopsia with a relative scotoma. Fluorescein Angiography (FA) demonstrated early hyperfluorescence of the lesion with late leakage. Optical Coherence Tomography (OCT) revealed subretinal fluid with macular edema. B-scan ultrasonography showed an acoustically solid, dome-shaped choroidal mass with high internal reflectivity, supporting the diagnosis of CCH. Intravitreal bevacizumab was administered for exudation, and Photodynamic Therapy (PDT) was planned as definitive management with close follow-up using VA assessment, OCT, and fundus photography.

Conclusion: CCH should be considered in adults presenting with an orange-red juxtapapillary choroidal mass and acute visual symptoms from exudative maculopathy. The combination of characteristic FA, OCT, and ultrasonography findings helps differentiate CCH from malignant and inflammatory choroidal lesions. Early diagnosis and timely treatment—often PDT, with anti-vascular endothelial growth factor (anti-VEGF) therapy as an adjunct for associated fluid— can improve or stabilize vision and reduce complications.