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Ben Brahem M, El Matri K, Fafloul Y, Chebbi A, Fekih O, Nacef L, El Matri L. Atypical case of choroidal osteoma associated to polypoidal choroidal vasculopathy and preretinal neovascular membrane. Eur J Ophthalmol 2024; 34:NP58-NP63. [PMID: 38644785 DOI: 10.1177/11206721241249218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
PURPOSE To report a very rare and atypical case of an elderly Caucasian female patient who developed perilesional multiple polypoidal choroidal vasculopathy (PCV) as a probable complication of choroidal osteoma (CO), associated to preretinal neovascular membrane overlying the lesion. METHODS Observational case report. CASE OBSERVATION A 60-year-old Caucasian woman presented with blurred vision in her right eye (RE). Fundus examination revealed a round white-yellowish calcified deep lesion in the juxta-papillary superior area, measuring 4 disc-diameters, with well-defined scalloped margins and an irregular surface. B-scan ultrasonography and orbital tomography confirmed the diagnosis of choroidal osteoma (CO). Further investigation with multimodal imaging including infracyanine green angiography, fluorescein angiography, swept source optical coherence tomography and angiography highlighted the presence of multiple aneurysmal choroidal dilations around the CO, corresponding to PCV. We also noted the presence of a preretinal neovascular membrane overlying the CO. The patient was monitored with regular follow-up since no signs of activity were detected on multimodal imaging. CONCLUSION Our case report represents an exceptional and atypical association between pre-retinal neovascularization, PCV and choroidal osteoma. While the mechanisms underlying the development of PCV and pre-retinal neovascularization in the setting of CO are not well understood, it is imperative for ophthalmologists to recognize this association as a potential cause of sudden vision loss in patients with CO, and to consider appropriate diagnostic and management strategies.
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Affiliation(s)
- Mohamed Ben Brahem
- Department of ophthalmology A, Institut Hédi Raies d'ophtalmologie de Tunis, Tunis, Tunisia
- Faculté de médecine de Tunis, Université Tunis - El Manar, Tunis, Tunisia
| | - Khaled El Matri
- Faculté de médecine de Tunis, Université Tunis - El Manar, Tunis, Tunisia
- Department of ophthalmology B, Institut Hédi Raies d'ophtalmologie de Tunis, Tunis, Tunisia
- Oculogenetic laboratory LR14SP01, Tunis, Tunisia
| | - Yousra Fafloul
- Faculté de médecine de Tunis, Université Tunis - El Manar, Tunis, Tunisia
- Department of ophthalmology B, Institut Hédi Raies d'ophtalmologie de Tunis, Tunis, Tunisia
- Oculogenetic laboratory LR14SP01, Tunis, Tunisia
| | - Amel Chebbi
- Faculté de médecine de Tunis, Université Tunis - El Manar, Tunis, Tunisia
- Department of ophthalmology C, Institut Hédi Raies d'ophtalmologie de Tunis, Tunis, Tunisia
| | - Olfa Fekih
- Department of ophthalmology A, Institut Hédi Raies d'ophtalmologie de Tunis, Tunis, Tunisia
- Faculté de médecine de Tunis, Université Tunis - El Manar, Tunis, Tunisia
| | - Leila Nacef
- Department of ophthalmology A, Institut Hédi Raies d'ophtalmologie de Tunis, Tunis, Tunisia
- Faculté de médecine de Tunis, Université Tunis - El Manar, Tunis, Tunisia
| | - Leila El Matri
- Faculté de médecine de Tunis, Université Tunis - El Manar, Tunis, Tunisia
- Department of ophthalmology B, Institut Hédi Raies d'ophtalmologie de Tunis, Tunis, Tunisia
- Oculogenetic laboratory LR14SP01, Tunis, Tunisia
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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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Mohankumar A, Mohan S, Rajan M. Polypoidal choroidal vasculopathy 20 years after resolution of tubercular choroiditis. Digit J Ophthalmol 2023; 29:94-96. [PMID: 37780035 PMCID: PMC10539005 DOI: 10.5693/djo.02.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
We report the case of a 72-year-old white woman with blurring of vision in both eyes of 15 days' duration. She had a history of treatment for bilateral tuberculosis choroiditis 20 years before. She was diagnosed with polypoidal choroidal vasculopathy in the right eye and inflammatory choroidal neovascular membrane in the left eye, based on multimodal imaging, including optical coherence tomography, fundus fluorescein angiography, and indocyanine green angiography. The right eye received 3 intravitreal injections of aflibercept and showed complete resolution. The left eye was treated with a single intravitreal injection of aflibercept.
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Scupola A, Ruggeri ML, Sammarco MG, Pagliara MM, Blasi MA. Photodynamic therapy for macular choroidal osteoma. Eur J Ophthalmol 2021; 32:NP82-NP87. [PMID: 33715490 DOI: 10.1177/11206721211000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To report a case of macular choroidal osteoma treated with photodynamic therapy. OBSERVATIONS A 34-years old woman with decreased visual acuity in her left eye came to our observation for assessment of an amelanotic choroidal tumor in the left eye. On the basis of ophthalmoscopic and echographic features the tumor was diagnosed as choroidal osteoma. Imaging examination revealed subretinal fluid involving the foveal area associated with alterations of outer neuroepithelial layers and photoreceptors without evidence of choroidal neovascularization. Foveal sparing standard fluence rate photodynamic therapy was performed. After treatment, subretinal fluid reabsorption and visual acuity recovery was noted with progressive restoration of foveal architecture. Due to the relapse of fluid and visual impairment, 1 year after treatment, a second PDT session was made using the same parameters and protocol of treatment. Despite a complete subretinal fluid reabsorption and visual acuity recovery the second treatment was complicated by the development of subretinal fibrosis. CONCLUSIONS PDT is effective to induce subretinal fluid reabsorption and visual recovery in choroidal osteoma located in the macular area. However, the risk of possible complications related to the treatment have to be considered.
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Affiliation(s)
- Andrea Scupola
- U.O.C. Oncologia Oculare, Dipartimento di Scienze dell'Invecchiamento Neurologiche, Ortopediche e della Testa Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Ludovica Ruggeri
- U.O.C. Oncologia Oculare, Dipartimento di Scienze dell'Invecchiamento Neurologiche, Ortopediche e della Testa Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Grazia Sammarco
- U.O.C. Oncologia Oculare, Dipartimento di Scienze dell'Invecchiamento Neurologiche, Ortopediche e della Testa Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Monica Maria Pagliara
- U.O.C. Oncologia Oculare, Dipartimento di Scienze dell'Invecchiamento Neurologiche, Ortopediche e della Testa Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Blasi
- U.O.C. Oncologia Oculare, Dipartimento di Scienze dell'Invecchiamento Neurologiche, Ortopediche e della Testa Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Huang YM, Zhang L, Liang J, Yuan RD. Bilateral choroidal osteoma with unilateral polypoidal choroidal vasculopathy treated with conbercept. Int J Ophthalmol 2020; 13:1009-1012. [PMID: 32566516 DOI: 10.18240/ijo.2020.06.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 02/12/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yan-Ming Huang
- Xinqiao Hospital of Army Medical University, Chongqing 400038, China
| | - Li Zhang
- Xinqiao Hospital of Army Medical University, Chongqing 400038, China
| | - Jin Liang
- Xinqiao Hospital of Army Medical University, Chongqing 400038, China
| | - Rong-Di Yuan
- Xinqiao Hospital of Army Medical University, Chongqing 400038, China
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Kim D, Ryu G, Sagong M. Polypoidal choroidal vasculopathy as a complication of choroidal osteoma: A case report. Medicine (Baltimore) 2020; 99:e19927. [PMID: 32443292 PMCID: PMC7253871 DOI: 10.1097/md.0000000000019927] [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 tumor that particularly affects young, healthy women. Its prognosis is influenced by complications, such as choroidal neovascularization (CNV), subretinal hemorrhage, subretinal fluid (SF), decalcification status, and overlying retinal pigment epithelium (RPE) atrophy. In case of CNV as the complication of CO, it is typically present in the classic form; however, reports on polypoidal choroidal vasculopathy (PCV) have been rare. Here, we report a case of an older, male patient with PCV as a complication of CO. PATIENT CONCERNS A 70-year-old male patient visited the hospital with vision impairment in the right eye since 2 weeks. DIAGNOSIS Fundus examination revealed a red-yellow, well-demarcated, scalloped lesion around the optic nerve in each eye; the lesions were highly reflective on ultrasound examination, and thus, CO was diagnosed. Indocyanine green fluorescence angiography and optical coherence tomography (OCT) revealed that the right eye also had PCV accompanied with SF. OCT confirmed the presence of large quiescent type 1 CNV bilaterally in decalcified areas of the lesions adjacent to the optic nerve. INTERVENTIONS Intravitreal bevacizumab (IB) injection was performed. OUTCOMES Best-corrected visual acuity had improved and OCT showed a decrease in the SF, while OCT angiography showed partial regression of branching vascular network. CONCLUSION CO can be accompanied by quiescent type 1 CNV; this should be closely monitored because it can progress to PCV. Optical coherence tomography, alongside indocyanine green fluorescence angiography, is useful for the diagnosis and monitoring of potential CNV as a complication of CO.
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Takkar B, Tandon N, Venkatesh P. De novo ossification of the choroid in a case of multifocal fibrosclerosis. Can J Ophthalmol 2018; 53:e62-e65. [PMID: 29631844 DOI: 10.1016/j.jcjo.2017.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Brijesh Takkar
- Retina and Uvea Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Venkatesh
- Retina and Uvea Services, Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Intravitreal bevacizumab monotherapy for choroidal neovascularisation secondary to choroidal osteoma. Eye (Lond) 2016; 30:843-9. [PMID: 27034203 DOI: 10.1038/eye.2016.50] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 01/19/2016] [Indexed: 11/08/2022] Open
Abstract
PurposeThe purpose of this study is to present the outcomes of a series of patients with choroidal neovascular membrane (choroidal neovascularisation (CNV)) secondary to a choroidal osteoma undergoing anti-VEGF monotherapy.Patients and methodsRetrospective series of patients with choroidal neovascularization secondary to choroidal osteoma. All patients underwent clinical and imaging assessment (fundus photo, B-scan ultrasonography, fluorescein angiography, and optical coherence tomography-where available), and were managed with intravitreal anti-VEGF injections (Bevacizumab). Visual acuity and central retinal thickness were recorded pre treatment and at the end of the follow-up period.ResultsEight patients were included in this study. Of this, 6/8 had predominantly classic or classic and 2/8 patients had minimally classic or occult CNV. Each patient received 3-10 injections of bevacizumab. Median follow-up was 9 months (3-15 months). Visual acuity improved in 5 patients, by 2-6 Snellen lines. CNV completely regressed in 5 cases and partially regressed in 3 cases. Mean CRT reduction was 122 μm (6 to -230 μm).ConclusionIntravitreal bevacizumab can be an effective treatment modality in the management of vision threatening CNV secondary to choroidal osteoma.
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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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Imamura Y, Engelbert M, Iida T, Freund KB, Yannuzzi LA. Polypoidal choroidal vasculopathy: a review. Surv Ophthalmol 2010; 55:501-15. [PMID: 20850857 DOI: 10.1016/j.survophthal.2010.03.004] [Citation(s) in RCA: 191] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 03/22/2010] [Accepted: 03/23/2010] [Indexed: 12/31/2022]
Abstract
More than a quarter century has passed since the original description of polypoidal choroidal vasculopathy (PCV) in 1982 as a peculiar hemorrhagic disorder involving the macula characterized by recurrent subretinal pigment epithelial bleeding. In the ensuing years, numerous reports have described the expanded clinical spectrum of this entity. PCV is the principal vascular composition of patients of pigmented races experiencing neovascular maculopathies, particularly African Americans and Asians. This form of neovascularization is now known to occur in white patients with or without concomitant drusen, and the site of involvement has extended from the peripapillary area to the peripheral fundus. Indocyanine green angiography has made detection of these abnormal vascular changes more reliable and definitive. More precise diagnosis has also led to a better understanding of specific clinical features that distinguish PCV from more typical proliferations of abnormal choroidal vessels. We review the nature of PCV, including its genetic basis, demographic features, histopathology, clinical manifestations, natural course, response to treatments, and the histopathological and genetic bases. We emphasize multimodal ophthalmic imaging of these vessels, in particular fluorescein and indocyanine green angiography and optical coherence tomography.
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Affiliation(s)
- Yutaka Imamura
- The LuEster T. Mertz Retinal Research Center, Manhattan Eye Ear and Throat Hospital, New York, New York, USA
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