title: Atypical Exophytic Retinal Capillary Hemangioma and Diagnostic Modalities.
abstract: OBJECTIVE
  Retinal capillary hemangioma (RCH) can occur in isolation or may be associated with von Hippel-Lindau disease. The classic RCH is described as a globular reddish lesion with a dilated feeding artery and a tortuous draining vein, indicative of a common endophytic growth pattern. Exophytic patterns are far more rare and, because of its subtle appearance, often missed or misdiagnosed.
  
  
  METHODS
  A 24-year-old woman presented with complaints of a mid-peripheral superior field defect OS. She had no family history of von Hippel-Lindau disease. Best-corrected visual acuity was 20/20 OD, OS. Dilated fundus examination of the left eye revealed a peripheral large inferotemporal retinal lesion with an overlying vascular network. Corresponding feeding and draining vasculature was not clearly noted on dilated fundus examination. Optical coherence tomography, ultrasonography, and fluorescein angiography testing were used to confirm the diagnosis of an exophytic peripheral RCH. Anti-vascular endothelial growth factor injections and cryotherapy were initiated, and the patient was scheduled for radioactive plaque brachytherapy. Genetic testing and proper scans were also recommended.
  
  
  CONCLUSIONS
  This case illustrates an atypical exophytic peripheral RCH, rarely reported in the literature. The utilization of a variety of diagnostic modalities was highly effective, aiding in the diagnosis of this condition.
authors.affiliation: *OD, FAAO †BS ‡MD, MBA, FACS Department of Optometry, Nova Southeastern University, Ft. Lauderdale, Florida (DLS, SM, JS); and Murray Ocular Oncology & Retina, Miami, Florida (ASG, TGM).
authors.forename: Diana L
authors.initials: DL
authors.lastname: Shechtman
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Gold
authors.forename: Samantha
authors.initials: S
authors.lastname: McIntosh
authors.forename: Jessica
authors.initials: J
authors.lastname: Steen
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Murray
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D000068258:Bevacizumab / Q000627:therapeutic use; D005260:Female; D005451:Fluorescein Angiography; D018324:Hemangioma, Capillary / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D058449:Intravitreal Injections; D019572:Retinal Neoplasms / Q000175:diagnosis* / Q000188:drug therapy; D012171:Retinal Vessels / Q000187:drug effects / Q000473:pathology*; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab