Choroidal excavation in choroidal osteoma complicated by choroidal neovascularization

Abstract

PurposeTo describe multimodal imaging features of choroidal osteoma (CO) complicated by choroidal neovascularization (CNV) and focal choroidal excavation (FCE).MethodsPatients presenting with CO and CNV between January and October 2016 were considered for this study. Diagnosis of CO was confirmed by ultrasound examination. All patients underwent multimodal imaging including optical coherence tomography (OCT), swept-source OCT angiography (DRI OCT Triton, Topcon, Inc., Tokyo, Japan) and fluorescein angiography (Spectralis HRA+OCT; Heidelberg Engineering, Heidelberg, Germany).ResultsTwo patients (one with bilateral CO) were included in the study. OCT showed a FCE in two eyes of two patients (one in correspondence of the CNV and the other adjacent to the CNV). OCT-A demonstrated presence of microvascular flow within neovascular network of the CNVs. Decalcification of the tumor was noted in correspondence of one eye with FCE.ConclusionsFCE may be found in eyes with choroidal osteoma and CNV. OCT-A was a valuable tool for detection of CNV complicating choroidal osteoma. Decalcification of choroidal osteoma may represent a common pathogenic pathway for development of FCE and CNV in choroidal osteoma.

Multimodal imaging in choroidal osteoma

“…Margolis et al [ 13 ] described the FCE in conforming lesions, in which the overlying retina is close to the RPE, and nonconforming lesions in which a hypo reflective space is visible between the retina and RPE, in our series one patient had conforming and the other one had nonconforming FCE. Pierro et al [ 14 ] described in two patients with CO the presence of CNV and FCE. CE has an increased separation between retinal pigment epithelium and neurosensory retina without schisis of the corresponding retinal layers; the location is in correspondence or in proximity of the tumor.…”

“…Table 2 . To our best knowledge Pierro et al [ 14 ] described two patients with CO and FCE in the proximity of CNV. In this series two eyes had CNV in the proximity of FCE and one eye had FCE in the boundaries of the osteoma and normal choroidal tissue.…”

“…AF: Decalcified tumor had reduced over all fluorescence Shields et al [ 11 ] 2015 15 EDI-OCT: horizontal lamellar lines, hyperreflective horizontal lines, horizontal and vertical tubular lamella. Photoreceptors were intact in ossified tumors meanwhile those were atrophic or thinning in deossified osteomas Pierro et al [ 14 ] 2017 3 FCE and CNV in CO. OCT-A is a useful skill to detect CNV Cennamo et al [ 17 ] 2017 6 OCT-A: fine vascular network within the tumor. EDI-OCT: horizontal lamellar lines, horizontal and vertical tubules and speckled regions.…”

The Role of Optical Coherence Tomography Angiography in Ranibizumab-Treated Choroidal Neovascularization in Choroidal Osteoma

“…CNV was seen most commonly in tumors with an irregular surface or overlying hemorrhage. Optical coherence tomography angiography (OCT-A) has been shown to be effective in evaluating CNV in patients with CO and those treated with anti-vascular endothelial growth factor (anti-VEGF) therapy [ 3 , 4 , 5 , 6 , 7 ].…”

Update: Juxtapapillary choroidal excavation with polypoidal choroidal vasculopathy - An unusual association

“…[3] Progressive decalcification of choroidal osteoma might play a common pathogenetic role for development of CNV and focal choroidal excavation (FCE) in these patients. [4]…”