Choroidal Osteoma Research Articles

Bilateral Choroidal Osteoma in Three Siblings

Three siblings (a sister and two identical-twin brothers) had bilateral choroidal osteomas. The sister was seen at 11 years of age, and the tumor showed significant growth two years later. The twin brothers' tumors were diagnosed at 9 years of age, and their conditions remained stable over two years except for a new, isolated lesion that occurred in one eye of one brother. The siblings' mother had a yellow mottling situated nasal to the disk in each eye that was similar in appearance to that in one eye of one of the twins. She showed no evidence of calcium on ultrasonography. The appearance of osteomas in three siblings suggests a choristoma as the cause of this tumor.

Spontaneous Decalcification of a Choroidal Osteoma

A 23-year-old woman presented with a clearly defined, pale orange choroidal tumor superior to the right optic disc in 1976. The patient was followed. After a choroidal osteoma was first reported in 1977, this diagnosis was confirmed in this patient using ultrasonography and orbital tomography. The lesion grew very slowly over the next 5 years. In 1981, the choroidal osteoma began to thin and decalcify. Subretinal neovascularization developed in 1982 and was treated with argon laser photocoagulation. In 1983, the tumor was thinner and less calcified. During the next 18 months, it became completely decalcified and essentially disappeared leaving only a bed of pigment epithelial and choriocapillaris atrophy. This was confirmed with fluorescein angiography and ultrasonography.

Photocoagulation of Subretinal Neovascularization Associated With Choroidal Osteoma

Photocoagulation of Subretinal Neovascularization Associated With Choroidal Osteoma

Review of Choroidal Osteoma: Successful Krypton Red Laser Photocoagulation of an Associated Subretinal Neovascular Membrane Involving the Fovea

Laser treatment of a subretinal neovascular membrane associated with a unilateral choroidal osteoma in a 28-year-old woman is described. To our knowledge, this is the first reported use of krypton red laser photocoagulation for the initial treatment of a subfoveal neovascular membrane in this setting. Early recognition of the membrane allowed treatment prior to involvement of the central fovea. Follow-up has shown obliteration of the membrane without recurrence and 20/20 vision. We emphasize recognition of this unusual tumor, self-monitoring with an Amsler grid, and early treatment of subretinal neovascularization in this high risk group of young patients.

CHOROIDAL OSTEOMA

Treatment of subretinal neovascular membranes associated with choroidal osteomas is described. Early recognition of the membranes, aided by Amsler grid self-assessment, allowed initiation of photocoagulation treatment while the lesions were still extrafoveal. In one patient, initial treatment was performed with the argon green laser and subsequent treatments were applied with the krypton red laser. In two other patients, argon-laser photocoagulation alone was used to destroy subretinal neovascular membranes. Post-treatment evaluations in one patient demonstrated persistence of recurrence of neovascular tissue and allowed for prompt retreatment. Follow-up evaluations have shown that treatment resulted in persistent destruction of the subretinal neovascular membrane in two patients, with stabilization of vision at 20/25- and 20/100, respectively. In one patient, vision has been stable at 20/50 for 6 months; however, a recurrent subretinal neovascular membrane developed, encroaching through the fovea with resultant visual loss of 20/60.

Choroidal Osteoma After Intraocular Inflammation

A 12-year-old girl had blurred vision and pain behind her left eye for three months. An examination disclosed focal choroiditis and optic nerve edema. Her visual acuity was 20/30. Two similar previous episodes had been diagnosed as scleritis and uveitis and the patient was still on a regimen of 5 mg of prednisone per day and eyedrops containing prednisolone and phenylephrine. A pink choroidal mass superotemporal to the optic disk was negative for calcium by computed tomography and ultrasonography. The corticosteroids were discontinued. Three months later, the patient's visual acuity had improved to 20/20 but the choroidal lesion was slightly larger and two new lesions had appeared, one just above the optic disk and the other superotemporal to the macula. Three years later the two new lesions had coalesced to form one lesion with vascular channels on its surface. Although a choroidal osteoma was suspected, computed tomography and ultrasonography were still negative for calcium. Five years after the initial examination, computed tomography showed a thin ring of calcium within the choroid at the location of the mass. Ultrasonography also confirmed the presence of calcium.

Bilateral Choroidal Osteomas Associated with Fatal Systemic Illness

An 11-year-old black boy complained of intermittent occipital headaches with nausea and projectile vomiting. Previous skin and lung biopsy specimens were interpreted as histiocytosis X. Cranial computed tomographic scanning disclosed a mass lesion in the region of the choroid plexus of the left lateral ventricle. This was surgically removed but proved nondiagnostic despite extensive histologic examination. An ophthalmologic evaluation showed discrete, elevated, yellow-white choroidal tumors in both maculas. The ophthalmoscopic appearance, as well as ultrasonography and computed tomography, led to the diagnosis of choroidal osteomas.

Amelanotic Choroidal Nevi

A review of 373 patients with presumed choroidal nevi revealed 19 (5.1%) to have largely or totally amelanotic nevi. All patients but one with amelanotic nevi were white, and all were 48 years of age or older. Each lesion was located posterior to the equator, had a mean diameter of 3.2 mm, and was less than or equal to 1 mm in elevation. Intravenous fluorescein angiography most often disclosed early and late hyperfluorescence, corresponding to the amelanotic areas of the nevus. No lesions were observed to grow during a mean 14-month follow-up period. The differential diagnosis of amelanotic nevi of the choroid is discussed and includes amelanotic malignant melanoma, cavernous hemangioma of the choroid, metastatic cancer to the choroid, posterior scleritis, choroidal osteoma, and hypopigmented congenital hypertrophy of the retinal pigment epithelium.

Bilateral Choroidal Osteomas

A 25-year-old woman had the characteristic ophthalmoscopic, ultrasonographic, and radiologic features of bilateral choroidal osteomas. She developed a macular hemorrhage in her right eye, believed to be secondary to choroidal neovascularization. Visual acuity improved remarkably.

Choroidal Osteoma

A 15-year-old white girl had a presumed choroidal hemangioma in the posterior pole of the right eye. The lesion appeared to grow, and we performed a phosphorous uptake test, which was positive. Subsequent studies demonstrated that the tumor was a choroidal osteoma.