Abstract
Purpose
Circumscribed choroidal hemangioma is a rare condition where there is development of benign vascular tumors, and it generally appears in middle-aged adults. Here we report a case of Chinese medicine, Gui Lu Er Xian Jiao – related serous retinal detachment secondary to circumscribed choroidal hemangioma.
Observations
A 55-year-old female, who had no remarkable ocular or medical history but has been taking a special Chinese compound medicine, Gui Lu Er Xian Jiao, for the past 2 years, presented with progressive blurred vision in the left eye for weeks. After serial ocular examinations, serous retinal detachment 2nd to circumscribed choroidal hemangioma was disclosed. Owing to the close timing association with medication history of Gui Lu Er Xian Jiao, we advised her to discontinue the Chinese medicine first. The serous retinal detachment resolved completely without any other management.
Conclusions and Importance
The content of Gui Lu Er Xian Jiao has been reported to have angiogenesis effect, which possibly change the vascular permeability and induce the serous retinal detachment and therefore blurred vision in our patient. To the best of our knowledge, this is the first report on such relationship between Gui Lu Er Xian Jiao and serous retinal detachment 2nd to circumscribed choroidal hemangioma. The case report highlighted the importance of detailed history taking in the management of ocular diseases.
1
Introduction
Circumscribed choroidal hemangioma, presents with progressive blurred vision, metamorphopsia, floaters, and visual field defects, is a rare and benign vascular tumor in middle-aged adults. The visual symptoms are caused by the development of cystoid macular edema, subretinal fluid, and retinal pigment epithelium changes, retinoschisis and subretinal fibrosis in long-standing cases. Treatment is indicated only when visual symptoms develop. Over the years, the management of choroidal hemangioma has evolved beginning with laser photocoagulation to transpupillary thermotherapy, plaque brachytherapy, photodynamic therapy, external beam radiotherapy and intravitreal injection of anti-vascular endothelial growth factor (VEGF) recently. We present the first case of Gui Lu Er Xian Jiao – related serous retinal detachment 2nd to circumscribed choroidal hemangioma. Serous retinal detachment resolved completely after discontinuation of Chinese medicine without any other treatment.
2
Case report
A 55-year-old female presented to the clinic with chief complaint of progressive blurred vision in her left eye for a period of time, especially recent weeks. Her medical and ocular history was unremarkable, except for taking a special Chinese compound medicine, Gui Lu Er Xian, Jiao for 2 years. At initial visit, her best-corrected visual acuities (BCVA) were 1.0, OD and 0.5, OS. Pupils were equal sized, round, and normal light reaction in both eyes. Anterior segment was remarkable except mild lens opacity in both eyes. An orange-red elevated mass lesion with overlying pigmentary change and subretinal fluid was noted over the superior arcade of the left eye. Macula was detached too ( Fig. 1 A).
Ancillary ultrasonography demonstrated a solid choroidal mass with high internal reflectivity on AB scan ( Fig. 2 ). The optical coherent tomography (OCT) revealed subretinal fluid over macula ( Fig. 3 A). Fluorescein angiography (FA) showed a large hyper-reflective mass, with large amounts of staining and late dye pooling ( Fig. 4 ). The tumor markers including CEA (Carcinoembryonic Antigen), CA 125 (cancer antigen 125), CA153 (cancer antigen 153), and CA199 (cancer antigen 199), were all within normal limits. Brain MRI (Magnetic Resonance Imaging) showed focal thickening with enhancement at the posterior part of the left eye globe without other remarkable findings ( Fig. 5 ).
