Lecture 7

Question 1

Retinal capillary hemangioma is a benign proliferation of what cells

Answer 1

Retinal capillary pericytes and endothelial cells.
Congenital defect of the entire vascular unit.

Since the endothelial cells are faulty, it will leak plasma and blood. Exudate may follow.

Question 2

Difference between peripheral and juxtapapillary retinal capillary hemangioma

Answer 2

Peripheral:

• Elevated
• Orange
• Large
• Feeder vessels

Juxtapapillary

• Intraretinal
• Red/pink
• Smaller
• No large feeder vessels

Question 3

Evolution of retinal capillary hemangioma

Answer 3

At first, subtle. Later in life, will become larger.

Faulty pericytes and endothelium–> leakage of plasma and blood –> Exudate –> traction –> Retinal detachment or neo.

Question 4

What is cavernous hemangioma of the retina?

Answer 4

Vascular tumor of the retina composed of numerous venous aneurysms. Located in the inner/superficial retinal layers and associated with excess glial production. No feeder vessels, unilateral.

Exudates and hemes are rare! Usually identified around age 23

Question 5

Management of cavernous hemangioma of the retina

Answer 5

Usually no tx. Most of the time, does not affect vision. unless glial proliferation travels to the macula.
If vit heme(rare), then laser tx.
Refer to CT to rule out neuro-oculocutaneous involvement

Question 6

What causes racemose hemangioma and evolution

Answer 6

Genetic factors that occur early in gestation lead to dysgenesis of vascular plexus. Remains stable. Observe. Refer to rule out WM syndrome.

Question 7

Appearance of choroidal hemangioma

Answer 7

Red/orange lesion with indistinct margins near the optic nerve.
May be overlying RPE changes or orange pigment
Associated with sub retinal fluid
High internal reflectivity

Question 8

Evolution of choroidal hemangioma and tx

Answer 8

Present at birth, usually undetectable.
Throughout life, can cause sub retinal edema and RPE changes. May progress to non-reg RD. If so, can use anti-vegF, laser tx, or PDT.

Question 9

How does cavernous hemangioma of the orbit present?

Answer 9

Women 20-60 years
Slowly progressive, painless proptosis causing decreased VA and diplopia.

If small, monitor. If large, excise.

Question 10

Cavernous hemangioma of the orbit may rarely present with

Answer 10

Cavernous hemangioma of the brain.