Treatment Modalities:

• Observation
  • Appropriate for small, peripheral tumors that do not compromise vision
• Laser photocoagulation
  • Useful for small tumors, usually as complement to other modalities
• Trans-scleral cryotherapy
  • May induce tumor regression
  • Adverse effects include macular edema, retinal detachment
• Photodynamic therapy/Transpupillary thermotherapy
  • Useful in inducing regression for tumors of moderate thickness
• Brachytherapy
  • Indicated for large lesions and those associated with retinal detachment
  • Adverse effects include dry eye, cataract, optic neuropathy/retinopathy, neovascular glaucoma
• Surgical resection
  • Indicated when tumors fail to respond to cryotherapy or in cases with persistent vitreous hemorrhage
• Intravitreal anti-VEGF
• Associated with temporary reduction in tumor thickness but have limited efficacy as long-term monotherapy

Back to our case:

• Patient offered: observation, cryotherapy, trans-pupillary thermotherapy
• Plan: Observation, avoid blood thinners and vigorous activity
• Five months later: Heme resolved, lesion inactive without recurrent exudation (and resolved SRF), observed

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