Use of iodine-125 episcleral brachytherapy treatment for circumscribed choroidal hemangioma in a pediatric patient

The purpose of this report is to highlight the results of iodine-125 episcleral plaque radiotherapy for the treatment of circumscribed choroidal hemangiomas (CCHs) as an alternative to photodynamic therapy. CCH are rare benign vascular hamartomas without systemic associations. We herein describe the treatment of a case of a pediatric patient with CCH associated with an exudative retinal detachment. His treatment consisted of brachytherapy with a plaque loaded with 125 Iodine seeds with a target apex dose of 40 Gy. Preoperative visual acuity (VA) in the affected right eye was 20/800. After treatment and for 24 months of follow-up, the VA improved to 20/200, with no signs of radiation retinopathy or recurrence of subretinal fluid. The favorable visual results, resolution of exudative retinal detachments, and the low rate of side effects lead us to conclude that iodine-125 episcleral brachytherapy should be considered in large tumors, those with a subfoveal location or the presence of extensive subretinal fluid.