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Dütsch M, Helbig H, Gamulescu MA, Barth T. [Long-term outcome of macular neovascularization secondary to choroidal osteoma with and without intravitreal anti-VEGF(vascular endothelial growth factor)- treatment]. DIE OPHTHALMOLOGIE 2023; 120:1258-1266. [PMID: 37661239 DOI: 10.1007/s00347-023-01912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/18/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Choroidal osteoma (CO) is a benign ossifying ocular tumor, which is unilateral in most cases. The CO may cause severe visual impairment, especially in the case of a secondary macular neovascularization (MNV). OBJECTIVE Based on a case series of patients with MNV secondary to CO, the variability of the clinical course with and without intravitreal anti-vascular endothelial growth factor (VEGF) treatment is presented. METHODS All patients diagnosed with secondary MNV due to CO between 2007 and 2023 were retrospectively assessed with respect to the clinical course. RESULTS In this study 7 eyes of 5 patients (4 women, 1 man) were diagnosed with secondary MNV due to CO. Intravitreal anti-VEGF treatment was carried out in 2 patients with unilateral MNV and 1 patient was treated in both eyes for bilateral MNV. In another case with bilateral MNV, only 1 eye was treated because of fibrosis in the other eye. A further case with unilateral CO and MNV scars at the initial diagnosis was left untreated. Overall, in 3 out of 5 eyes treated with intravitreal VEGF inhibition stabilization or improvement of visual acuity could be achieved. CONCLUSION In our case series intravitreal anti-VEGF treatment attained a functional stabilization or improvement in 3 out of 5 treated eyes. In one case of CO-associated MNV fibrosis rapidly developed without treatment. Therefore, the clarification for patients with CO about the lifelong risk for development of a secondary MNV is essential in individual cases for early treatment. As no standardized treatment scheme for intravitreal VEGF antibodies for CO-related MNV exists, the treatment is planned on an individual basis.
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Affiliation(s)
- M Dütsch
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - H Helbig
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - M-A Gamulescu
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
| | - T Barth
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
- Department of Ophthalmology, University Medical Centre Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
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Zhang L, Ran QB, Lei CY, Zhang MX. Clinical features and therapeutic management of choroidal osteoma: A systematic review. Surv Ophthalmol 2023; 68:1084-1092. [PMID: 37321477 DOI: 10.1016/j.survophthal.2023.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Abstract
Choroidal osteoma is a benign ossifying tumor within the choroid. Complications associated with choroidal osteoma, including disruption of retinal pigment epithelium, atrophy of photoreceptors, subretinal fluid, and choroidal neovascularization, present challenges for clinicians, and management remain controversial. We performed a comprehensive search in the PubMed, EMBASE, and Ovid databases for published studies and case reports relating to the management of choroidal osteoma. Since it was first described in 1978, various case reports of ocular complications associated with choroidal osteoma have been documented, and various therapies have yielded different outcomes. We systematically evaluate the literature published on this rare entity.
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Affiliation(s)
- Li Zhang
- Sichuan University West China Hospital, Chengdu, China.
| | - Qi-Bo Ran
- Sichuan University West China Hospital, Chengdu, China.
| | - Chun-Yan Lei
- Sichuan University West China Hospital, Chengdu, China.
| | - Mei-Xia Zhang
- Sichuan University West China Hospital, Chengdu, China.
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Kang HG, Kim TY, Lee J, Byeon SH, Kim SS, Kim M. Predicting Visual Outcomes in Choroidal Osteoma Treated with Anti-vascular Endothelial Growth Factor. Am J Ophthalmol 2022; 244:143-151. [PMID: 35970208 DOI: 10.1016/j.ajo.2022.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 07/07/2022] [Accepted: 08/05/2022] [Indexed: 01/30/2023]
Abstract
PURPOSE To determine potential factors associated with the long-term visual prognoses in patients with choroidal osteoma undergoing anti-vascular endothelial growth factor (VEGF) treatment. DESIGN Retrospective case series. METHODS Patients diagnosed at tertiary high-volume hospitals between January 2000 and December 2020 were evaluated. The primary outcome measure was visual acuity at 5-year follow-up. The secondary outcome measures included factors associated with favorable vision, defined as loss of <1 line and >20/200 vision. RESULTS Of 38 eyes from 36 patients (22 female, 61%; mean age 38 years) with choroidal osteoma, 23 eyes (61%) received anti-VEGF treatment (bevacizumab 1.25mg/0.05 cc, monthly or treat-and-extend) and 65% completed the 5 years of follow-up. All treated eyes had associated chorioretinal comorbidities (subretinal fluid 91%; choroidal neovascularization 74%; subretinal hemorrhage 30%). Although there was significant vision loss by 5 years (P = .002), 12 eyes (44%) had favorable outcomes. Only tumor thickness was significantly associated with unfavorable visual outcomes (OR 917.1, 95% CI 1.0-5687.7; P = .049). The optimal cut-off point predictive of visual outcomes was 1.4 mm, and tumor thickness ≥ 1.4 mm was associated with unfavorable vision (OR 27.0, 95% CI 2.0-368.4; P = .013). CONCLUSIONS Among patients with choroidal osteoma undergoing anti-VEGF therapy, a particular patient subset presented with divergent outcomes with very poor vision. Tumor thickness appeared to be the differentiating factor and is thus a potential prognostic indicator for long-term visual prognoses.
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Affiliation(s)
- Hyun Goo Kang
- From Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (H.G.K, S.H.B, S.S.K); Translational Genome Informatics Laboratory, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea (H.G.K)
| | - Tae Young Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (T.Y.K, J.L, M.K)
| | - Junwon Lee
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (T.Y.K, J.L, M.K)
| | - Suk Ho Byeon
- From Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (H.G.K, S.H.B, S.S.K)
| | - Sung Soo Kim
- From Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (H.G.K, S.H.B, S.S.K)
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (T.Y.K, J.L, M.K).
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Rong LY, Ran L, Li SY, Meng XH, Long YL, Xu HW. Intravitreally injected ranibizumab versus photodynamic therapy for CNV secondary to choroidal osteoma: a 7-year follow-up case report. Int J Ophthalmol 2021; 14:940-944. [PMID: 34150552 DOI: 10.18240/ijo.2021.06.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Li-Yuan Rong
- Southwest Hospital, Southwest Eye Hospital, the Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China.,The Ophthalmology Division of Chinese People's Liberation Army General Hospital, Beijing 100039, China
| | - Li Ran
- Southwest Hospital, Southwest Eye Hospital, the Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Shi-Ying Li
- Southwest Hospital, Southwest Eye Hospital, the Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China.,Department of Ophthalmology, Xiang'an Hospital of Xiamen University; Medical Center of Xiamen University; School of Medicine, Xiamen University, Xiamen 361102, Fujian Province, China.,Eye Institute of Xiamen University, Xiamen 361102, Fujian Province, China
| | - Xiao-Hong Meng
- Southwest Hospital, Southwest Eye Hospital, the Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Yan-Ling Long
- Southwest Hospital, Southwest Eye Hospital, the Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Hai-Wei Xu
- Southwest Hospital, Southwest Eye Hospital, the Third Military Medical University (Army Medical University), Chongqing 400038, China.,Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
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Yao B, Wang F, Zhao X, Wang B, Liu G, Ding Y. Optical coherence tomography angiography findings of choroidal neovascularization secondary to decalcified choroidal osteoma treated with intravitreal aflibercept: A case report. Medicine (Baltimore) 2020; 99:e21472. [PMID: 32791764 PMCID: PMC7386993 DOI: 10.1097/md.0000000000021472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Choroidal osteoma (CO) is a rare benign ocular tumor characterized by ossifying choroid lesions. To the best of our knowledge, this is the first detailed report to describe the optical coherence tomography angiography (OCTA) findings of choroidal neovascularization (CNV) complicated by a rare decalcified CO following intravitreal aflibercept injection. PATIENT CONCERNS A 26-year-old woman presented with a spontaneous but painless reduction in visual acuity in her left eye that had commenced 5 days prior. DIAGNOSIS Clinical manifestations and multimodal imaging, including OCTA, spectral-domain optical coherence tomography, fundus fluorescein angiography and indocyanine green angiography, indicated decalcified CO with CNV. INTERVENTIONS After receiving an appropriately detailed explanation of the procedure, the patient was treated via intravitreal aflibercept(2.0 mg) injection once. OUTCOMES One month after the therapy, OCTA revealed that the flow areas of CNV were narrowed, the best-corrected visual acuity was improved to 20/30, however, 2 months follow-up OCTA revealed that the CNV reoccurred, the best-corrected visual acuity was dropped to 20/50. CONCLUSION Intravitreal aflibercept injection was an effective treatment for CO with CNV, but the effects may not last long. The OCTA findings provide a better appreciation of evaluating the effects of intravitreal aflibercept injection for CO complicating CNV.
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Affiliation(s)
- Bangtao Yao
- Department of Ophthalmology, Lishui District People's Hospital, Lishui Branch of Southeast University Affiliated Zhongda Hospital
| | - Fei Wang
- Department of Ophthalmology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xiaogui Zhao
- Department of Ophthalmology, Lishui District People's Hospital, Lishui Branch of Southeast University Affiliated Zhongda Hospital
| | - Bei Wang
- Department of Ophthalmology, Lishui District People's Hospital, Lishui Branch of Southeast University Affiliated Zhongda Hospital
| | - Gang Liu
- Department of Ophthalmology, Lishui District People's Hospital, Lishui Branch of Southeast University Affiliated Zhongda Hospital
| | - Yuhua Ding
- Department of Ophthalmology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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Grzybowski A, Kanclerz P. The Role of Steroids and NSAIDs in Prevention and Treatment of Postsurgical Cystoid Macular Edema. Curr Pharm Des 2019; 24:4896-4902. [PMID: 30727876 DOI: 10.2174/1381612825666190206104524] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/24/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pseudophakic cystoid macular edema (PCME) remains one of the most common visionthreatening complication of phacoemulsification cataract surgery (PCS). Pharmacological therapy is the current mainstay of both prophylaxis, and treatment of PCME in patients undergoing PCS. We aimed to review pharmacological treatment options for PCME, which primarily include topical steroids, topical nonsteroidal antiinflammatory drugs (NSAIDS), periocular and intravitreal steroids, as well as anti-vascular endothelial growth factor therapy. METHODS The PubMed and Web Of Science web platforms were used to find relevant studies using the following keywords: cataract surgery, phacoemulsification, cystoid macular edema, and pseudophakic cystoid macular edema. Of articles retrieved by this method, all publications in English and abstracts of non-English publications were reviewed. Other studies were also considered as a potential source of information when referenced in relevant articles. The search revealed 193 publications. Finally 82 articles dated from 1974 to 2018 were assessed as significant and analyzed. RESULTS Based on the current literature, we found that corticosteroids remain the mainstay of PCME prophylaxis in uncomplicated cataract surgery, while it is still unclear if NSAID can offer additional benefits. In patients at risk for PCME development, periocular subconjunctival injection of triamcinolone acetonide may prevent PCME development. For PCME treatment the authors recommend a stepwise therapy: initial topical steroids and adjuvant NSAIDs, followed by additional posterior sub-Tenon or retrobulbar corticosteroids in moderate PCME, and intravitreal corticosteroids in recalcitrant PCME. Intravitreal anti-vascular endothelial growth factor agents may be considered in patients unresponsive to steroid therapy at risk of elevated intraocular pressure, and with comorbid macular disease. CONCLUSION Therapy with topical corticosteroids and NSAIDs is the mainstay of PCME prophylaxis and treatment, however, periocular and intravitreal steroids should be considered in refractory cases.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
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Leung EH, Stout JT. I Went in for a Routine Eye Examination. J Pediatr Ophthalmol Strabismus 2018; 55:352. [PMID: 30452763 DOI: 10.3928/01913913-20181018-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Statement of the BVA, the DOG, and the RG on treatment of choroidal neovascularization in diseases other than neovascular age-related macular degeneration : Dated Ocotber 2017. Ophthalmologe 2018; 116:1-9. [PMID: 30406470 DOI: 10.1007/s00347-018-0810-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Tanigasalam V, Bhat BV, Manivannan S, Munisamy M, Parchand S. Choroid Osteoma in Schimmelpenning-Feuerstein-Mims Syndrome. Indian Pediatr 2018. [DOI: 10.1007/s13312-018-1305-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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[Statement from the BVA, the DOG, and the RG on treatment of choroidal neovascularization in diseases other than neovascular age-related macular degeneration : October 2017]. Ophthalmologe 2018. [PMID: 29520492 DOI: 10.1007/s00347-018-0679-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kim C, Choi KS, Sun HJ. A Case of Choroidal Osteoma with Subretinal Hemorrhage Improved by Intravitreal Bevacizumab and Aflibercept Injections. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.10.989] [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)
- Charm Kim
- Department of Ophthalmology, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Kyung Seek Choi
- Department of Ophthalmology, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hae Jung Sun
- Department of Ophthalmology, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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OCT-angiographische Darstellung einer choroidalen Neovaskularisation infolge eines Aderhautosteoms. Ophthalmologe 2017; 114:843-847. [DOI: 10.1007/s00347-016-0392-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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