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Fluorescein cap

Fluorescein angiographic feature of retinal cavernous hemangioma

Kumar, Madhu; Reddy, Navaneetha; Konana, Vinaya Kumar; Kanakamedla, Ashok; Ruia, Surabhi1; Gudimetla, Jayamadhury

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Indian Journal of Ophthalmology: October 2018 - Volume 66 - Issue 10 - p 1473-1474
doi: 10.4103/ijo.IJO_852_18
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Retinal cavernous hemangioma is a benign vascular tumor seen in young patients.[12] It rarely grows and is usually unilateral. It is commonly seen in peripheral retina and rarely over or adjacent to disc, with saccular angiomatous lesion with bunch of grapes appearance [Fig. 1a].[1] On fundus fluorescein angiography the lesion appears hypofluorescent in early phase [Fig. 1b] and with pooling of dye in upper half of saccule in late phase giving an appearance of “fluorescein cap” [Fig. 1c]. This pattern can be attributed to plasma–erythrocytes interface due to stagnant blood.[3] Hence fluorescein angiography is a vital diagnostic tool in clinching diagnosis of retinal cavernous hemangioma.

Figure 1
Figure 1:
(a) Color photograph showing saccular angiomatous lesion with bunch of grapes appearance just above the disc. (b) Fundus fluorescein angiography of the lesion showing hypofluorescence in early phase. (c) Fundus fluorescein angiography showing pooling of dye in upper half of saccule in late phase giving an appearance of “fluorescein cap”

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1. Shields JA, Shields CLShields JA, Shields CL. Vascular tumors of the retina and optic disc Intraocular Tumors, An Atlas and Textbook. 20082nd ed Philadelphia, PA Lippincott, Williams & Wilkins:382–9
2. Gass JD. Cavernous hemangioma of the retina. A neuro-oculo-cutaneous syndrome Am J Ophthalmol. 1971;71:799–814
3. Shanmugam PM, Ramanjulu R. Vascular tumors of the choroid and retina Indian J Ophthalmol. 2015;63:133–40
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