Choroidal Osteoma with Choroidal Neovascular

Meeting
Corner
MonthlyMonthly
Meeting
Corner
Choroidal Osteoma with Choroidal
Neovascular Membrane (CNVM)
Anil B. Gangwe
MD
Anil B. Gangwe MD
Dr. Rajendra Prasad Centre for Ophthalmic Sciences,
All India Institute of Medical Sciences
A
38 years old female presented with gradual, painless,
progressive decrease in vision in right eye since two
months. This was associated with distortion of images. She
had no similar complains previously in either of the eye.
She had no known systemic illness and did not undergo
any form of treatment for it. Family members had no similar
type of complains.
Examination revealed best corrected visual acuity of 6/24 in
right eye and 6/6 in left eye. Anterior segment examination
was unremarkable. Fundus examination showed 7.8×
6.5 mm oval shaped, orange yellow coloured, minimally
elevated choroidal lesion located at the posterior pole
(Figure 1). It had smooth but irregular margins. Area near
the edge of lesion showed areas of RPE drop outs. RPE
overlying the lesion was normal. An area of greenish grey
colour with adjacent sub retinal bleed was located within
the lesion just superior to fovea.
Ultrasound B-scan of right eye showed highly echogenic
lesion with post acoustic shadowing. A
scan through the same region showed high
Fig.1
amplitude (100%) spike. Fundus fluorescein
angiography (FFA) showed an area with the
lesion of early hyper fluorescence which
increased in size and intensity with time. It
also showed areas of blocked fluorescence
and window defect corresponding to sub
retinal bleed and RPE dropout respectively.
Optical coherence tomograpy (OCT)
revealed a sub retinal choroidal neovascular
membrane complex with sub retinal fluid
(Figure 2).
With these clinical findings and investigations
a diagnosis of right of choroidal osteoma
with CNVM was made. Patient was
planned for right eye intravitreal injection of
Bevacizumab in view of associated active CNVM. Patient
was followed up after 4 weeks of injection and subjectively
improved vision and decreased metamorphopsia. BCVA
improved to 6/18p. Sub retinal bleed resolved OCT showed
decreased size of CNVM complex and associated fluid.
To summarise, choroidal osteoma is a rare tumour typically
seen in young female. It needs to be diffentiated from some
serious entities like choroidal metastasis and amelanotic
melanoma. Choroidal osteoma usually does not require
any treatment. Long term follow up is advocated as the
lesion may develop CNVM or may undergo decalcification.
CNVM is seen in 46–56% by 20 years of follow up and
is leading cause of low vision. Choroidal osteoma with
CNVM mandates treatment that includes photocoagulation,
Photodynamic therapy (PDT) and intravitreal injection of
Anti- vascular endothelial growth factor (VEGF). Recent
reports have shown favourable response with anti- VEGF
treatment.
Fig.2
Figure 1: Fundus photograph showing 7.8× 6.5 mm oval, orange yellow elevated choroidal lesion
Figure 2: OCT showing sub-retinal choroidal neovascular membrane with sub retinal fluid
www. dosonline.org l 71