Swept-source optical coherence tomographic findings of choroidal osteoma

Inner Choroidal Fibrosis: An Optical Coherence Tomography Biomarker of Severity in Chronic Central Serous Chorioretinopathy

PURPOSE

To describe a potential biomarker termed as inner choroidal fibrosis in cases of chronic central serous chorioretinopathy (CSCR) presenting to a tertiary referral center.

DESIGN

Observational case series.

METHODS

Five eyes of 4 patients with CSCR were noted to have a gray-white subretinal lesion in the macula, which was analyzed with multimodal imaging.

RESULTS

The lesions were hypofluorescent on autofluorescence, fundus fluorescein angiography, and indocyanine angiography. In all cases, a characteristic heterogeneous, hyperreflective lesion in the inner choroid was seen on optical coherence tomography (OCT), corresponding to the white subretinal lesions. The lesion was distinct from the adjacent choroid, with greater reflectivity and greater thickness than the adjacent compressed choroidal vasculature. The dilated outer pachyvessels were pushed outward or sideways in all cases. On OCT-angiography, the corresponding lesion showed flow void areas. We have termed this zone of inner choroidal hyperreflectivity "inner choroidal fibrosis." Upon analyzing the clinical course, 3 of the patients had a history of choroidal neovascularization. The contralateral eye in 2 of these 3 patients also developed choroidal neovascularization. Three of the eyes had an overlying focal choroidal excavation.

CONCLUSIONS

We report a potential biomarker of CSCR termed "inner choroidal fibrosis" in 4 cases of chronic CSCR. It can best be identified on enhanced depth or swept source OCT as a region of heterogeneous hyperreflectivity in the inner choroid. This fibrosis could be regarded as a degenerative process secondary to more severe disease in the past.

Clinical Observation of Choroidal Osteoma Using Swept-Source Optical Coherence Tomography and Optical Coherence Tomography Angiography

Choroidal neovascularization (CNV) secondary to choroidal osteoma (CO) can cause profound visual loss, but detecting CNV and the tumor’s feeder vessels using traditional fluorescent angiography imaging is challenging. Newly developed TowardPi swept-source optical coherence tomography (SS-OCT) and OCT angiography (SS-OCTA) enable ultra-high resolution, enhanced penetration with longer wavelength (1060 nm), a rapid scan rate (400 KHz), reduced loss of signal strength with increasing depth, and 120° angular widefield of fundus view, enabling a nearly histological description of the retina and choroid. We therefore used this SS-OCT and SS-OCTA platform to observe the intrinsic features of osteoma in 23 eyes of 21 patients. It was found that the borders of CO were clearly demarcated from the adjacent choroidal Sattler’s and Haller’s layers, while on a corresponding B-scan the blood flow of the CO was detected mainly within the choriocapillaries and partly within Sattler’s layer. The CNV was identified as numerous branching or radiating vessels connecting with intrinsic feeder vessels displaying various patterns including ginseng, instant noodle, growth ring, tangle, spider web, medusa, seafan, and irregular shape. Moreover, tumor-like tissues were found to grow above the disrupted Bruch’s membrane. SS-OCTA can be used to detect the tumor vasculature in CO.

In vivo optical biopsy of choroidal osteoma: a swept source optical coherence tomography-based tumor characterization

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.

Choroidal Osteoma Deossification Visualized by Enhanced Depth Imaging Spectral-Domain Optical Coherence Tomography

Choroidal osteoma (CO) is a rare, benign ossifying lesion of the choroid found in otherwise healthy patients. Although associated with good visual prognosis, tumor deossification in choroidal osteoma has been linked with vision loss, presumably due to overlying photoreceptor degeneration. Here the authors present a case of CO in an elderly male demonstrating tumor deossification and photoreceptor atrophy during a 3-year follow-up using enhanced depth imaging optical coherence tomography (EDI-OCT). Visual acuity was maintained due to the tumor's noncentral location. Patients with CO should undergo regular imaging with EDI-OCT to screen for tumor deossification and impending vision loss. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:87-90.].