Choroidal Osteoma Research Articles

Clinical Features and Treatment Outcomes of Choroidal Osteoma in Asian Indians (80 Patients)

Purpose: To describe the demographic and clinical characteristics, and treatment outcomes of choroidal osteoma in Indian patients. Methods: This cross-sectional hospital-based study included 80 patients (100 eyes) between 2nd October 2012 and 15th May 2024. Results: Forty-nine (61%) participants were female, and 31 (39 %) were male. The most common age group was the second decade (n=27, 34%). Tumor ossification with intact RPE was observed in 37 (44%) eyes and tumor deossification with/without RPE atrophy was observed in 55 (65%). Associated features observed were choroidal neovascularization (CNV) in 40 (40%) eyes, subretinal fluid without CNV in 4 (4%) eyes, and documented tumor growth in 6 (6%) eyes (mean interval, 4 years). At 4 and 8 years, Kaplan–Meier analysis revealed tumor growth in 18% and 38% of eyes, respectively. Of the 83 eyes, OCT showed the presence of choroidal lamellae in ossified zones in 30 eyes (100%), CNV in 40 (48%) eyes, SRF without CNV or growth in 8 (10%) eyes, and RPE atrophy with deossification in 53 (64%) eyes. Treatment included intravitreal anti-VEGF therapy for CNV in 39 eyes, transpupillary thermotherapy in 3, and focal laser photocoagulation in one eye to the perifoveal leaning edge with SRF without CNV. The mean BCVA changed from 0.4 to 0.6 logMAR units (6/15 to 6/24 Snellen’s equivalent) at a mean follow-up of 19 months (3-149 months). Conclusion: Choroidal osteoma is a unilateral condition observed in females. Although benign, the presence of CNV, SRF, or tumor growth requires treatment and periodic surveillance.

Coexistence of choroidal osteoma, focal choroidal excavation, and choroidal neovascularization

Coexistence of choroidal osteoma, focal choroidal excavation, and choroidal neovascularization

A rare presentation of asymptomatic multifocal choroidal osteoma

A rare presentation of asymptomatic multifocal choroidal osteoma

A Case of Ocular Sarcoidosis with an Atypical Presentation of Subretinal Mass

Purpose: To describe a case of ocular sarcoidosis manifesting as an atypical subretinal mass.Case summary: A 59-year-old woman reported reduced visual acuity in her left eye lasting for 1 month. Her best corrected visual acuity in the left eye had diminished to 0.3. A fundus examination revealed a whitish elevated lesion, approximately one disc diameter in size, in the perimacular area of the left eye. Optical coherence tomography identified a hyporeflective oval-shaped mass in the choriocapillaris region accompanied by subretinal fluid. Initial assessment suggested choroidal osteoma with choroidal neovascularization. Consequently, the patient underwent two intravitreal bevacizumab injections, which did not lead to improvement. To rule out systemic diseases, including syphilis, tuberculosis, and sarcoidosis, further radiologic and laboratory tests were conducted. A chest computed tomography highlighted mediastinal lymph node enlargement and pervasive nodules in both lung parenchymata, and serum angiotensin-converting enzyme levels were elevated to 77 U/L. Based on these findings, a diagnosis of sarcoidosis was confirmed, and the patient commenced treatment with oral prednisolone. Eight weeks after treatment, the subretinal lesion and fluid had resolved, and the best corrected visual acuity in the patient’s left eye had improved to 0.9.Conclusions: Ocular sarcoidosis can manifest as a subretinal mass. This presentation should be differentiated from other subretinal lesions.

Choroidal Osteoma with Choroidal Neo Vascular Membrane

Choroidal osteoma (CO) is a rare benign tumor usually unilateral and have a female preponderance. We report a case of a 34-year-old healthy malediagnosed with unilateral Choroidal Osteoma with an associated Choroidal NeoVascularMembrane(CNVM).Thediagnosiswasconfirmedbasedonclinicalexamination, typical findings on B-scan, Fundus fluorescein angiography,Indocyanine green angiography and Optical coherence tomography. The CNVMwas treated with intravitreal Bevacizumab injections and showed a good responseinitially.TherewasarecurrenceofCNVMovertwoyearswhenpatientwaslosttofollow-up. Treatmentwith intravitreal Ranibizumab bio similar injection helpedstabilize hisvision. Regular follow-up is essential for timely treatment ofrecurrenceof CNVMand optimum visualoutcomes.

Case Report: Choroidal osteoma: Bone in the eye

We share a case of a 16-year-old girl who presented with blurring of vision in her left eye since 1 year, with fundus examination suggestive of choroidal osteoma. The detailed clinical, complimentary examinations, and multimodal imaging – fundus photo, optical coherence tomography, fundus fluorescein angiography, and B-scan ultrasonography – of the case are discussed. Choroidal osteoma is a rare benign ossifying tumor of unknown etiology characterized by mature bone replacing choroid, more commonly unilateral and predominantly affecting young females, typically manifesting in the teenage years or in the early 20s. Although choroidal osteoma is a rare benign tumor, accurate diagnosis is important because it is similar to amelanotic choroidal melanoma and metastatic choroidal carcinoma which require treatment and it is important to keep patients under observation for early detection of treatable choroidal neovascularization and other complications.

Choroidal osteoma secondary to chronic posterior scleritis: A case report and literature review

Choroidal osteoma is a rare benign ossifying tumor of the choroid. Posterior scleritis is an uncommon yet potentially sight-threatening inflammation of the sclera. Herein, we report a case of choroidal osteoma secondary to chronic posterior scleritis accompanied by a literature review. Decalcification of the tumor, choroidal neovascularization, and retinal pigment epithelium atrophy can result in blindness. Hence, patients with recurrent posterior scleritis need long-term follow-up; in addition, we need to be alert for complications, such as choroidal osteoma, which can ultimately lead to a poor visual prognosis.

Multiple Choroidal Neovascularizations in Choroidal Osteoma Treated with Anti-VEGF Injections: A 6-Year Follow-Up Case Report.

To report a case of multiple choroidal neovascularizations (CNVs) secondary to choroidal osteoma injected with a total of 13 anti-vascular endothelial growth factor (VEGF) drugs over a long-term follow up of 6-year period. Case report. A 29-year-old female presented with a peripapillary choroidal osteoma in her left eye with the best-corrected visual acuity (BCVA) of 20/25. After 2 years of follow-up, two foci of CNV (one was at the infra-nasal of the optic disc, and the other was near the sub-temporal vascular arch), and massive subretinal hemorrhage developed overlying the osteoma, causing decreased BCVA of 20/33. The patient was treated with four consecutive intravitreal injections of conbercept and the two CNVs regressed with BCVA recovered to 20/25. While 17 months later, the third CNV lesion locating at the fovea appeared and nine more injections of aflibercept were given during which repeated recurrence of it occurred. At last follow-up, 6 years from baseline, all the three CNV foci were controlled, with final BCVA of 20/33. Multiple CNVs may appear simultaneously at different locations in one osteoma and prompt treatment with intravitreal anti-VEGF may be a good option to control the progression and recurrence of these CNVs. Long-term follow-up and multimodal imaging are vital in the management of CO-associated CNV.

Clinical case of bilateral rapidly progressive osteoma of the choroid

Choroidal osteoma is a benign neoplasm characterized by the appearance of mature bone tissues at the level of the choroid and unilateral development. This study highlights a clinical case of bilateral rapidly progressing osteoma of the choroid in a child, which was complicated by tumor decalcification and choroidal neovascularization. A 14-year-old male teen has been under observation in the S. Fyodorov Eye Microsurgery Federal State Institution, Saint-Petersburg branch since 2019, for bilateral choroidal osteoma. At the initial visit, a yellow-orange lesion with clear boundaries was noted in the left eye, localized at the level of the choroid and parapapillary, and had a trabecular bone structure. Based on the clinical picture and data from instrumental studies (ultrasound and optical coherence tomography), he was diagnosed with choroidal osteoma. During observation, a similar lesion appeared in the right eye, and its relatively rapid growth was observed in both eyes. Owing to the absence of zones of decalcification and neovascularization, further follow-up was initiated. However, in the presence of zones of decalcification of the bone tissue and newly formed vessels of the choroid, a threefold intravitreal injection of an angiogenesis inhibitor was performed. Consequently, regression of choroidal neovascularization was observed. Speculatively, the main reason for the atypical disease course in this teenager is the specificity of bone tissue development in childhood and adolescence.

CHOROIDAL OSTEOMA IN AN INFANT

Purpose: To describe a case of choroidal osteoma with macular involvement in an infant that was treated with transpupillary thermotherapy. Methods: A case report. Results: An 11-month-old infant presented for retinopathy of prematurity follow up examination and was found to have a three disc-diameter round, orange, subretinal, slightly elevated lesion with well-defined margins in the superior macula of the left eye. B-scan ultrasonography showed a slightly elevated, highly reflective choroidal mass with acoustic shadowing. A diagnosis of choroidal osteoma was made. Six months later, repeat examination under anesthesia (EUA) showed the lesion to be increasing in size and encroaching on the fovea. Given demonstrated growth and the risk of central vision loss, the patient was treated with transpupillary thermotherapy (TTT). Subsequent EUAs, over a period of four months, have shown complete decalcification with no subsequent growth. Conclusion: Choroidal osteomas are benign lesions that can be sight threatening if located in the macula. TTT in this case resulted in complete regression of a sight threatening extrafoveal choroidal osteoma at four month follow up.

Differential diagnosis of myopic choroidal neovascularization (mCNV): insights from multimodal imaging and treatment implications.

The aim of this article is to conduct a comprehensive systematic review about the current understandings and differential diagnosis of myopic choroidal neovascularization (mCNV) and other several similar diseases, describing their multimodal imaging analysis, prognostic implications, and current types of management. This systematic review was performed based on a search on the PubMed database of relevant papers regarding mCNV and other entities discussed in the paper, according to our current knowledge. Through the integration of a multimodal imaging approach, especially optical coherence tomography (OCT), along with accurate demographic and clinical assessment, it becomes possible to effectively differentiate mCNV from similar yet heterogeneous entities. These conditions include macular hemorrhage due to new lacquer crack (LC) formation, inflammatory diseases such as punctate inner choroidopathy (PIC)/multifocal choroidits (MFC) and epiphenomenon multiple evanescent white dot syndrome (Epi-MEWDS), neovascular age-related macular degeneration (nAMD), idiopathic CNV (ICNV), dome-shaped macula (DSM) with subretinal fluid, retinal pigment epithelium (RPE) humps, angioid streaks (AS), choroidal rupture (CR), and choroidal osteoma (CO). Each one of these entities will be described and discussed in this article. Myopic choroidal neovascularization is a common retinal condition, especially among young individuals. Accurate diagnosis and differentiation from similar conditions are crucial for effective treatment. Multimodal imaging, particularly OCT, plays a crucial role in precise assessment. Future research should focus on defining biomarkers and distinguishing features to facilitate prompt treatment.

Choroidal amelanotic mass with vermiform margins, vision loss, and extreme fatigue.

To describe a case of a previously healthy middle-aged male with an atypical choroidal mass and fatigue. Case report. A 56-year-old Caucasian male presented with decreased vision in the right eye (OD) and a choroidal amelanotic mass OD with subretinal fluid. He received bevacizumab (1.25 mg/0.05 mL) injections by multiple providers without improvement in vision and with tumor progression. Visual acuity was 20/400 OD and 20/25 left eye (OS). The anterior segment was unremarkable in both eyes (OU). He was referred with suspected diagnosis of choroidal melanoma, metastasis, or osteoma. On examination, a choroidal amelanotic tumor with vermiform margins measuring 12 mm in base and 1.8 mm in thickness was seen OD. Smaller satellite lesions were noted inferiorly. Fundus OS was normal. Infectious evaluation was unrevealing and angiotensin-converting enzyme, lysozyme, and chest x-ray were normal. Fine-needle aspiration biopsy was declined by the patient. Given the clinical suspicion of choroidal sarcoidosis with characteristic tumor color, vermiform margins, and presence of satellite lesions, oral corticosteroids 60 mg/day for 2 months were started, followed by sub-Tenons triamcinolone acetonide (40mg/1 mL) injection three months later and urgent rheumatologic evaluation. He self-discontinued the oral corticosteroids and the tumor progressed by the next follow-up. Oral corticosteroids were restarted at 80mg/day. 16 months after his presentation to us, he experienced fatigue with electrocardiogram findings of third-degree heart block from sarcoidosis. He received an intracardiac defibrillator and 80 mg/day of corticosteroids with plans to initiate methotrexate for stronger immunosuppression. Understanding the numerous manifestations of ocular and systemic sarcoidosis is crucial. Choroidal sarcoidosis characteristically exhibits vermiform margins. Close follow-up and systemic monitoring is necessary in patients presenting with ocular signs of sarcoidosis. The diagnosis of choroidal sarcoidosis can be challenging. Features including vermiform tumor margins, satellite lesions, and choroidal infiltration on OCT are suggestive of choroidal sarcoidosis. All patients with ocular sarcoidosis should be monitored for systemic involvement. In this case, the ocular manifestation guided the diagnosis and eventually the treatment of cardiac sarcoidosis.

Uncomplicated choroidal osteoma in a one-eyed patient

Uncomplicated choroidal osteoma in a one-eyed patient

CHOROIDAL OSTEOMA: REVIEW OF LITERATURE AND FIRST CASE FROM YEMEN

Juxtapapillary choroidal tumors called choroidal osteomas are benign and do not require medical attention. They predominantly occur in young females (median age, 20 years). Ophthalmoscopy and fluorescein angiography can disclose indicative ocular signs, but computed tomography (CT), echography, and plain radiography are particularly crucial for making the right diagnosis. These lesions may be clinically misdiagnosed as a number of dystrophic lesions, as metastatic carcinoma, atypical malignant choroidal melanoma, metastatic carcinoma, leukemic or lymphoma infiltration, choroidal macular scarring, choroidal hemangiomas, or organized subretinal hemorrhage. As therapeutic methods, radiation and enucleation, it is crucial to rule out malignant melanoma from the differential diagnosis. According to an assessment of the literature, all reported instances with CT scans exhibited calcific densities that could be easily seen in the affected eye's posterior pole. The clinical, radiologic, and pathologic findings in our patient are all typical. We emphasize the importance of CT in assessing choroidal osteoma as well as the uniqueness of CT results. Peer Review History: Received: 11 August 2023; Revised: 14 September; Accepted: 28 October, Available online: 15 November 2023 Academic Editor: Dr. Rola Jadallah, Arab American University, Palestine, rola@aauj.edu Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.5/10 Reviewers: Prof. Gorkem Dulger, Duzce University, Turkey, gorkemdulger@yandex.com Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com

Osseous and Myogenic Tumors of the Choroid

Myogenic and osseous tumors of the choroid are extremely rare clinical manifestations. The most common osseous choroidal tumor is choroidal osteoma, and the most common myogenic choroidal tumor is choroidal leiomyoma. Other common osseous lesions are listed as sclerochoroidal calcification and ossified choroidal hemangioma. It is of great importance to distinguish these lesions from malignant tumors, especially malignant melanoma. Multimodal imaging methods and tissue diagnosis with biopsy and immunohistochemical markers in myogenic tumors have an important place in the diagnosis. Although it is known that these lesions are systemically benign, they can threaten vision as a result of local mass effect and complications. Since some osseous tumors may accompany systemic metabolic disorders, systemic screening should be performed in necessary cases. Although rare, metastatic choroidal leiomyosarcoma cases have been described. In this case, it is important to diagnose the tumor quickly and accurately with a good anamnesis and tissue diagnosis, and to plan the appropriate treatment considering the sensitivity of the primary tumor.

Long-term outcome of macular neovascularization secondary to choroidal osteoma with and without intravitreal anti-VEGF(vascular endothelial growth factor)- treatment

Choroidal osteoma (CO) is abenign ossifying ocular tumor, which is unilateral in most cases. The CO may cause severe visual impairment, especially in the case of asecondary macular neovascularization (MNV). 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. All patients diagnosed with secondary MNV due to CO between 2007 and 2023 were retrospectively assessed with respect to the clinical course. In this study 7eyes of 5patients (4women, 1man) were diagnosed with secondary MNV due to CO. Intravitreal anti-VEGF treatment was carried out in 2 patients with unilateral MNV and 1patient was treated in both eyes for bilateral MNV. In another case with bilateral MNV, only 1eye 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 5eyes treated with intravitreal VEGF inhibition stabilization or improvement of visual acuity could be achieved. 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.

Ocular findings in Schimmelpenning–Feuerstein–Mims syndrome

Schimmelpenning–Feuerstein–Mims syndrome (SFM), also known as organoid nevus syndrome or linear nevus sebaceous of Jadassohn, is a rare congenital phacomatosis. It includes cutaneous sebaceous nevus along with skeletal, neurological, cardiovascular, and ocular abnormalities. We report a case of a 14-year-old boy with this rare SFM syndrome. We highlight the various ocular features observed in this patient such as epibulbar choristoma, symblepharon, and choroidal osteoma along with the systemic features and discuss the management of each.

OUR EXPERIENCE IN THE TREATMENT OF CHOROIDAL OSTEOMA

Choroidal osteoma is a rare, benign formation of the choroid, which occurs most often in women of working age and characterized by the formation of neovascularization in 31-47% of cases, even the development of bilateral optic nerve atrophy is described. The etiology of the disease remains unknown, persistent associations with other ocular or systemic diseases, as well as with any disorders of calcium or phosphorus metabolism, have not been described in the literature. The paper presents a clinical case of diagnosis and treatment of choroidal osteoma, which was combined with secondary serous retinal detachment. A patient underwent a closed subtotal vitrectomy with endotamponade with 1300cc silicone oil due to an existing choroidal osteoma, which was complicated by secondary retinal detachment. The course of the early postoperative period was uneventful, but 2 weeks after surgical treatment, signs of inflammation of the anterior part of the vascular tract occurred with the formation of precipitates and secondary ophthalmohypertension, decrease in visual acuity, the Tyndall effect, which gradually led to the formation of a pigmented exudate in the anterior chamber. Anti-inflammatory and hypotensive therapy allowed to minimize the manifestation of inflammatory changes and to restore normotonia. As a result of the complex treatment, it was possible to improve the visual acuity and restore the morphological structure of the retina, but the functional results after the treatment remained low, which, in our opinion, may be related to the topographical location of the osteoma, since localization in the paramacular zone can not have some positive prognosis in postoperative period. Also, the existing long-term retinal detachment and complications in the early postoperative period could affect the low functional results after the surgical treatment.

Long term results of photodynamic therapy in intraocular tumors

PurposeTo report long term results of photodynamic therapy (PDT) as treatment for intraocular tumors MethodsRetrospective interventional case series of 15 patients. All patients treated with standard-fluence PDT (83 s; 50 J/cm2) using verteporfin. Outcome measuresTumor diameter, tumor thickness, subretinal fluid resolution, best-corrected visual acuity,intraocular pressure and PDT complications. Results10 patients (66.7% of total patients) were diagnosed with choroidal hemangioma, 3 patients (20% of total patients) were diagnosed with choroidal melanoma, and 2 patients (13,3% of total patients) were diagnosed with choroidal osteoma.. Mean follow-up time was 33±18 months. The mean visual acuity was determined as 1.29 ± 0.98 logMAR in the examinations just before the PDT application. At the end of the follow-up period, the mean visual acuity was calculated as 1.41 ± 1.07 logMAR. While VA increased in 3 (20%) patients and decreased in 5 (33.3%) patients; It was determined that VA value did not change after treatment in 7 (46.7%) patients. The mean lesion diameter before PDT was 6573 ± 2115 µm (range; 1500–10,000 µm). The mean tumor thickness before PDT was 3624 ± 1404 µm (range; 600–6000 µm). The mean lesion diameter after treatment was 6026 ± 2521 µm (range; 0–9000 µm), and the mean tumor thickness after treatment was 2280 ± 1740 µm (range; 0–6000 µm).After the PDT, tumor size decreased in 8 (53.3%) patients, increased in 3 (20%) patients, and no change in tumor size was observed in 4 (26.7%) patients. Mean IOP values of all patients were 14.06 ± 3.17 mmHg before treatment; after treatment, it was measured as 13.46 ± 1.70 mmHg. After the treatment, geographic atrophy developed in 1 (6.7%) patient, cystoid macular edema developed in 1 (6.7%) patient, Retinal Pigment Epithelium (RPE) and choroidal atrophy developed in 1 (6.7%) patient. ConclusionThere are not enough cases of each to clearly distinguish between these 3 types of ocular cancers.However PDT may be a good option in the treatment of intraocular tumors with the chance of selective treatment and successful response.

Choroidal osteoma: a rare clinical picture

Choroidal osteoma is a rare benign bone tumor. It is unilateral in two thirds of cases. It occurs unilaterally and more often in young women. The tumor is most often located near the papilla. The complications classically described are progressive retinal atrophy and choroidal neovascularization. We report the case of a 39-year-old female patient, with no previous history, who consulted us for a sudden unilateral decrease in visual acuity, associated with metamorphopsias and a para-central scotoma. Fundus examination of the right eye revealed a large, yellowish-white choroidal tumor with fairly well-delineated margins in a juxta-papillary arrangement. Fluorescein angiography showed an early hyperfluorescence becoming intense at late times, associated with papillary edema. In front of this picture, we evoke the hypothesis of a choroidal neovascular membrane. The optical coherence tomography (OCT) showed the presence of a hyper-reflective pre-epithelial lesion in the inter-papillomacular region, associated with a retinal serous detachment, indicating a choroidal neovascular complication. B-mode ultrasonography confirmed the diagnosis by showing a hyperechoic thickening of the choroid with a posterior shadow cone. In our case, it was a choroidal osteoma complicated by optic neuropathy and choroidal neovascularization. The patient received several intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF), followed by long-term monitoring. Choroidal osteoma is a rare benign tumor. It often progresses slowly, but may have complications, in particular choroidal neovascularization, the treatment of which is not well codified. The long-term visual acuity is often very poor.