A man in his 20s presented reporting blurry vision in his right eye. Visual acuity was 20/25 OD. Fluorescein angiography revealed a nonleaking macular lesion with late intermixed lobules of hyperfluorescence and hypofluoresence consistent with a retinal cavernous hemangioma (Figure).
Retinal cavernous hemangiomas are typically low-flow lesions and thus not associated with transudation (fluid, lipid), which aids in their differentiation from Coats disease and capillary hemangioblastomas.1 Macular retinal cavernous hemangiomas are rare and they can occasionally be associated with vision loss.2,3 Because retinal macrovessels can occur as an asymptomatic finding independent of other retinal vascular abnormalities, one cannot exclude with certainty the possibility that the retinal macrovessel is coincident to the retinal cavernous hemangioma. Nevertheless, these images illustrate the possible association of a retinal cavernous hemangioma with a congenital retinal macrovessel, underlining the role of abnormal vascular development in the rise of each of these lesions.4
Thanos A, Randhawa S, Drenser KA. Macular Retinal Cavernous Hemangioma Associated With Congenital Retinal Macrovessel. JAMA Ophthalmol. 2016;134(9):e161683. doi:10.1001/jamaophthalmol.2016.1683