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Azad SV, Kumar V, Chawla R, Kashyap B, Temkar S, Kumar A, Venkatesh P, Vohra R, Molla K, Sharma A. In vivo optical biopsy of choroidal osteoma: a swept source optical coherence tomography-based tumor characterization. Ther Adv Ophthalmol 2020; 12:2515841420922740. [PMID: 32518894 PMCID: PMC7252358 DOI: 10.1177/2515841420922740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 03/02/2020] [Indexed: 11/26/2022] Open
Abstract
Objective: To study tumor characteristics of choroidal osteoma by swept source optical coherence tomography. Methods: A retrospective case series done at tertiary referral center in northern India. All patients diagnosed with choroidal osteoma examined on swept source optical coherence tomography were included. Swept source optical coherence tomography images were analyzed for integrity of retinal layers—intraretinal layers, outer retinal layers (photoreceptor), retinal pigment epithelium, and contour abnormalities. Choroidal changes assessed were tumor attributes such as shape, depth of choroidal involvement, tumor mass reflectivity pattern, tumor vascularity, and evolutionary structural abnormalities such as deossification, focal depressions, or choroidal neovascular membrane. Results: A total of 15 eyes of 11 patients were analyzed. Seven of 11 patients were females. Mean age of presentation was approximately 26 years. Tumor was large in nine cases (>7.5 mm). Deossification was seen in 12 eyes. Inner and outer retinal integrity was maintained in 7 and 2 eyes, respectively. Most common internal tumor reflectivity pattern seen was a lamellar appearance (12/15). Increased signal transmission to choroid and focal area of deep excavation was present in 11 and 4 eyes, respectively. Osteoclastic activity was noted in 12 eyes. Choroidal neovascular membrane was seen in 6 eyes. Small lesions showed lamellar pattern of tumor reflectivity with preservation of retinal pigment epithelium and overlying retina. Larger tumors were deossified with 6 irregular tumor contour, disorganization of the outer retina, increased signal transmission to choroid, and areas of osteoclastic activity. Conclusion: Swept source optical coherence tomography was helpful in assessing tumor attributes and predicting the different timelines in tumor evolution.
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Affiliation(s)
| | - Vinod Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi 110029, India
| | - Bibhuti Kashyap
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Shreyas Temkar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Atul Kumar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Pradeep Venkatesh
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Rajpal Vohra
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Kabiruddin Molla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Anu Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Balsnæs P, Szabo D, Takacs A, Papp A, Nagy ZZ, Schneider M. Enhanced depth imaging and swept-source optical coherence tomography findings in choroidal osteoma: a case report. SPEKTRUM DER AUGENHEILKUNDE 2019. [DOI: 10.1007/s00717-019-0427-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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3
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Choroidal osteoma. OPHTHALMOLOGY JOURNAL 2016. [DOI: 10.17816/ov9377-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This study describes the clinical features, methods of diagnosis, and treatment of a rare intraocular tumor, choroidal osteoma, based on our observation of three patients and a literature review.
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Abstract
Choroidal osteomas are rare benign ossifying tumors that appear as irregular slightly elevated, yellow-white, juxtapapillary, choroidal mass with well-defined geographic borders, depigmentation of the overlying pigment epithelium; and with multiple small vascular networks on the tumor surface. Visual loss results from three mechanisms: Atrophy of the retinal pigment epithelium overlying a decalcified osteoma; serous retinal detachment over the osteoma from decompensated retinal pigment epithelium, and most commonly from choroidal neovascularization. Recent evidence points to the beneficial effects of intravitreal vascular endothelial growth factor antagonists in improving visual acuity in serous retinal detachment with or without choroidal neovascularization.
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Affiliation(s)
- Ramzi M Alameddine
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | - Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | - Eman Kahtani
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Hayashi Y, Mitamura Y, Egawa M, Semba K, Nagasawa T. Swept-source optical coherence tomographic findings of choroidal osteoma. Case Rep Ophthalmol 2014; 5:195-202. [PMID: 25120475 PMCID: PMC4127548 DOI: 10.1159/000365184] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose To report the morphologic features of a choroidal osteoma using swept-source optical coherence tomography (SS-OCT) and fundus autofluorescence (FAF). Methods Two eyes of two cases with a choroidal osteoma were studied using SS-OCT and FAF. Results The location of the tumor was circumpapillary without macular involvement in case 1 and juxtapapillary with macular involvement in case 2. Both cases had a mixture of calcified and decalcified areas, and a concomitant choroidal neovascularization was found in case 2. The FAF images showed decreased autofluorescence in the central decalcified regions and relatively preserved fluorescence in marginal calcified regions in both cases. SS-OCT revealed a normal inner retina and an abnormal outer retina in both cases, and subretinal fluid in case 2. The calcified regions appeared sponge-like and were multilayered in case 2. A lamellar reflective pattern was observed in the decalcified regions in case 1, and hyperreflective mound-like areas were observed in both cases. SS-OCT demonstrated hyperreflective areas above Bruch's membrane accompanied by disruption of Bruch's membrane in case 1. The chorioscleral border was visible in both cases. Conclusions The FAF pattern in the calcified and decalcified areas of the choroidal osteoma may correspond to the different stage of tumor evolution. The SS-OCT findings indicate that choroidal osteomas can have characteristic reflective patterns and alterations of the overlying retina.
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Affiliation(s)
- Yuki Hayashi
- Department of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Himeji, Japan
| | - Yoshinori Mitamura
- Department of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Himeji, Japan
| | - Mariko Egawa
- Department of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Himeji, Japan
| | - Kentaro Semba
- Department of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Himeji, Japan
| | - Toshihiko Nagasawa
- Department of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Himeji, Japan ; Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, Japan
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7
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Adhi M, Bryant JS, Alwassia AA, Chen C, Duker JS. De novo appearance of a choroidal osteoma in an eye with previous branch retinal vein occlusion. Ophthalmic Surg Lasers Imaging Retina 2013; 44:77-80. [PMID: 23410812 PMCID: PMC3717569 DOI: 10.3928/23258160-20121221-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 11/13/2012] [Indexed: 11/20/2022]
Abstract
This report describes the de novo appearance of a choroidal osteoma occurring 8 years after laser photocoagulation for previous branch retinal vein occlusion (BRVO). A 62-year-old man presented with an asymptomatic yellowish orange lesion in the macula on fundus examination of his left eye during a regular follow-up visit for bilateral BRVO associated with macular edema that had previously been treated with laser photocoagulation. The lesion was observed for 1.5 years until a decrease in vision occurred. Fundus photography revealed a yellow-to-orange, well-defined lesion in the macular region. Fluorescein angiography was consistent with choroidal neovascularization (CNV). Optical coherence tomography and B-scan ultrasonography showed features consistent with choroidal osteoma. This is the first report of the de novo appearance of a choroidal osteoma occurring years after laser photocoagulation for BRVO. CNV developed secondary to the lesion, which was treated with intravitreal bevacizumab, leading to subjective and anatomic improvement.
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Affiliation(s)
- Mehreen Adhi
- New England Eye Center, Tufts Medical Center, Boston, Massachusetts 02111, USA
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Navajas EV, Costa RA, Calucci D, Hammoudi DS, Simpson ER, Altomare F. Multimodal fundus imaging in choroidal osteoma. Am J Ophthalmol 2012; 153:890-895.e3. [PMID: 22265155 DOI: 10.1016/j.ajo.2011.10.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 10/20/2011] [Accepted: 10/20/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe the morphologic features of calcified and decalcified choroidal osteomas using multimodal imaging and correlate these findings with a previous histopathologic study. DESIGN Retrospective observational case series. METHODS Three patients with choroidal osteoma underwent complete ophthalmologic examination, fundus photography, and multimodal fundus imaging, including Fourier-domain optical coherence tomography (FD-OCT) and blue-light fundus autofluorescence (bAF). RESULTS FD-OCT imaging of calcified tumors revealed a distinctive latticework pattern of reflectivity resembling the spongy bone structure seen histopathologically. On bAF the fluorescence was relatively well preserved overlying calcified tumors. In decalcified areas 2 patterns of reflectivity were identified: the first consisted of areas of relative hyperreflectivity with a lamellar appearance while the second was characterized by heterogeneous, hyperreflective, mound-like irregular areas associated with some posterior optical shadowing. Decalcified tumor areas had reduced overall fluorescence on bAF. CONCLUSION FD-OCT demonstrated different reflectivity patterns in both calcified and decalcified portions of the choroidal osteoma, which may correspond to different stages of tumor evolution. A distinctive latticework pattern of reflectivity similar to spongy bone was seen in calcified tumors. These observations improve our knowledge of the in vivo structure of choroidal osteomas and may have implications for the diagnosis and management of this tumor.
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Affiliation(s)
- Eduardo V Navajas
- Department of Ophthalmology and Vision Sciences, Princess Margaret Hospital, University of Toronto, Ontario, Canada.
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Say EAT, Shah SU, Ferenczy S, Shields CL. Optical coherence tomography of retinal and choroidal tumors. J Ophthalmol 2011; 2012:385058. [PMID: 23008756 PMCID: PMC3139893 DOI: 10.1155/2011/385058] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 05/07/2011] [Indexed: 01/06/2023] Open
Abstract
Optical coherence tomography (OCT) has revolutionized the field of ophthalmology since its introduction 20 years ago. Originally intended primarily for retina specialists to image the macula, it has found its role in other subspecialties that include glaucoma, cornea, and ocular oncology. In ocular oncology, OCT provides axial resolution to approximately 7 microns with cross-sectional images of the retina, delivering valuable information on the effects of intraocular tumors on the retinal architecture. Some effects include retinal edema, subretinal fluid, retinal atrophy, photoreceptor loss, outer retinal thinning, and retinal pigment epithelial detachment. With more advanced technology, OCT now provides imaging deeper into the choroid using a technique called enhanced depth imaging. This allows characterization of the thickness and reflective quality of small (<3 mm thick) choroidal lesions including choroidal nevus and melanoma. Future improvements in image resolution and depth will allow better understanding of the mechanisms of visual loss, tumor growth, and tumor management.
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Affiliation(s)
- Emil Anthony T. Say
- Oncology Service, Wills Eye Institute, Thomas Jefferson University, Suite 1440, 840 Walnut Street, Philadelphia, PA 19107, USA
| | - Sanket U. Shah
- Oncology Service, Wills Eye Institute, Thomas Jefferson University, Suite 1440, 840 Walnut Street, Philadelphia, PA 19107, USA
| | - Sandor Ferenczy
- Oncology Service, Wills Eye Institute, Thomas Jefferson University, Suite 1440, 840 Walnut Street, Philadelphia, PA 19107, USA
| | - Carol L. Shields
- Oncology Service, Wills Eye Institute, Thomas Jefferson University, Suite 1440, 840 Walnut Street, Philadelphia, PA 19107, USA
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Optical coherence tomography of retinal and choroidal tumors. J Ophthalmol 2011; 2012:385058. [PMID: 23008756 PMCID: PMC3139893 DOI: 10.1155/2012/385058] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 05/07/2011] [Indexed: 02/03/2023] Open
Abstract
Optical coherence tomography (OCT) has revolutionized the field of ophthalmology since its introduction 20 years ago. Originally intended primarily for retina specialists to image the macula, it has found its role in other subspecialties that include glaucoma, cornea, and ocular oncology. In ocular oncology, OCT provides axial resolution to approximately 7 microns with cross-sectional images of the retina, delivering valuable information on the effects of intraocular tumors on the retinal architecture. Some effects include retinal edema, subretinal fluid, retinal atrophy, photoreceptor loss, outer retinal thinning, and retinal pigment epithelial detachment. With more advanced technology, OCT now provides imaging deeper into the choroid using a technique called enhanced depth imaging. This allows characterization of the thickness and reflective quality of small (<3 mm thick) choroidal lesions including choroidal nevus and melanoma. Future improvements in image resolution and depth will allow better understanding of the mechanisms of visual loss, tumor growth, and tumor management.
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Lim HJ, Bae MC, Park JW, Cho YW, Park DJ. Optical Coherence Tomography and Multifocal Electroretinography in a Patient with Choroidal Osteoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.1.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hye Jin Lim
- Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea
| | - Min Chul Bae
- Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea
| | - Joon Woo Park
- Department of Ophthalmology, Changwon Fatima Hospital, Changwon, Korea
| | - Young Wook Cho
- Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea
| | - Dae Jin Park
- Department of Ophthalmology, Daegu Fatima Hospital, Daegu, Korea
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Shields CL, Perez B, Materin MA, Mehta S, Shields JA. Optical Coherence Tomography of Choroidal Osteoma in 22 Cases. Ophthalmology 2007; 114:e53-8. [PMID: 17884171 DOI: 10.1016/j.ophtha.2007.07.037] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 07/06/2007] [Accepted: 07/31/2007] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate the retinal status overlying choroidal osteoma using optical coherence tomography (OCT). DESIGN Retrospective noncomparative case series. PARTICIPANTS Twenty-two eyes with choroidal osteoma. METHODS Choroidal osteoma was studied with fundus photography, ultrasonography, and OCT. MAIN OUTCOME MEASURE Retinal status over the calcified and decalcified portions of choroidal osteoma. RESULTS There were 8 completely calcified and 14 partially decalcified choroidal osteomas. Optical coherence tomography was performed over the calcified portion in 21 eyes and over the decalcified portion in 10 eyes. The calcified portion displayed an overlying intact inner retina (n = 21 [100%]), intact outer retina (n = 20 [95%]), and intact photoreceptor layer (n = 21 [100%]). In contrast, the decalcified portion showed an intact inner retina (n = 9 [90%]) and markedly thinned to absent outer retina and photoreceptor layers (n = 10 [100%]). Of the 18 eyes with subfoveolar choroidal osteoma, visual acuity (VA) was 20/20 to 20/50 in all 11 eyes with calcified tumor, and OCT confirmed preservation of retinal architecture. In contrast, VA was 20/200 or worse in all 7 eyes with subfoveolar decalcified tumor, correlating with OCT findings of outer retinal thinning and photoreceptor loss. CONCLUSIONS The retina shows profound outer layer thinning and photoreceptor loss over decalcified choroidal osteoma. These findings correlate with poor VA over decalcified subfoveolar choroidal osteoma compared with good VA over calcified subfoveolar tumor.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
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Chen J, Lee L, Gass JDM. Choroidal osteoma: evidence of progression and decalcification over 20 years. Clin Exp Optom 2006; 89:90-4. [PMID: 16494612 DOI: 10.1111/j.1444-0938.2006.00012.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Choroidal osteoma is a rare, benign, ossifying tumour of the choroid of unknown aetiology. In contrast to other types of intraocular ossification, choroidal osteoma is found typically in young healthy females in the second or third decades of life with no history of systemic or ocular disease. Choroidal osteoma is a deep, pale yellow lesion with distinct geographic borders at the juxtapapillary or macular region, with branching 'spider' vessels on the surface of the tumour. These features should help differentiate choroidal osteoma from other types of intraocular tumour and the diagnosis can be confirmed with ultrasonography and computerised tomography. Here we report an initially unilateral case of choroidal osteoma, which decalcified over 20 years but during the same period the fellow eye also developed a choroidal osteoma to become a bilateral case. Despite the benign nature of the tumour, vision may be compromised by gradual atrophy of the overlying retina, serous retinal detachment, accumulation of sub-retinal fluid and sub-retinal haemorrhage associated with choroidal neovascularisation. Frequent examinations are recommended for patients with choroidal osteoma, for early detection of a subretinal neovascular membrane and potential treatment with laser photocoagulation.
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Affiliation(s)
- Jennifer Chen
- School of Optometry, Queensland University of Technology, Brisbane, Australia.
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Abstract
PURPOSE OF REVIEW Optical coherence tomography has assumed an important role in the management of numerous ocular conditions. With regard to ocular oncology, optical coherence tomography can illustrate retinal changes overlying choroidal tumors. Some of these features include photoreceptor loss, intraretinal edema, and retinal thinning overlying choroidal nevus; fresh subretinal fluid with preservation of photoreceptors overlying choroidal melanoma; and intraretinal edema, retinoschisis, and retinal thinning overlying irradiated choroidal melanoma. RECENT FINDINGS The optical coherence tomography features of tumors of the retinal pigment epithelium include typical findings of peaked vitreoretinal traction and retinal disorganization with combined hamartoma of the retina and retinal pigment epithelium, full-thickness retinal shadowing with congenital simple hamartoma, and photoreceptor loss and retinal thinning overlying congenital hypertrophy of the retinal pigment epithelium. SUMMARY Optical coherence tomography of retinal tumors, such as retinoblastoma and astrocytic hamartoma, reveals full-thickness replacement of the retinal anatomic layers with the tumor and shadowing corresponding to the intralesional calcification. For all intraocular tumors, optical coherence tomography provides valuable information regarding the status of the retina and the retinal pigment epithelium and can be useful in ascertaining reasons for visual loss.
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Affiliation(s)
- Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Rennie IG. Things that go bump in the light. The differential diagnosis of posterior uveal melanomas. Eye (Lond) 2002; 16:325-46. [PMID: 12101438 DOI: 10.1038/sj.eye.6700117] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
PURPOSE To examine the cross-sectional structure of a choroidal osteoma using optical coherence tomography. METHODS Observational case report. A choroidal osteoma in the right eye of a 22-year-old woman was studied with fluorescein and indocyanine green fundus angiograms and optical coherence tomography. RESULTS The optical coherence tomography showed that a creamy-white lesion in the tumor had an increased reflectivity with a cavernous structure, whereas an orange lesion showed less reflectivity beneath the apparently intact retinal pigment epithelium. The area of less-intense whiteness in the creamy-white lesion showed higher reflectivity at the level of the retinal pigment epithelium, which precluded our viewing the deeper structure of the tumor. CONCLUSION Optical coherence tomography can demonstrate the cavernous structure of a choroidal osteoma at a selective stage of a tumor's evolution, namely, when the retinal pigment epithelium is atrophied and the ossification is premature.
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Affiliation(s)
- Ayako Fukasawa
- Department of Ophthalmology, Yamanashi Medical University, Tamaho, Yamanashi, Japan
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