Long-term success of intravitreal bevacizumab for choroidal neovascularization associated with choroidal osteoma

Abstract

Purpose:To describe a case of choroidal osteoma with choroidal neovascularization (CNV) that was successfully treated with two intravitreal injections of bevacizumab (IVB).Design and methods:Case report on a 12-year-old Japanese girl who presented with a sudden decrease in vision in her left eye. At the first visit, 2 days after the onset of her symptoms, her visual acuity (VA) in her left eye was 0.2. Ophthalmoscopy showed a hemorrhage of 5 disc diameters under the retinal pigment epithelium and a serous retinal detachment at the posterior pole of the left eye. These findings were confirmed by optical coherence tomography. Fluorescein angiography (FA) and indocyanine green angiography (ICGA) showed several points of leakage around the fovea, which suggested a CNV. From these findings, the patient was diagnosed with choroidal osteoma with a CNV. The submacular hemorrhage was from the CNV associated with the choroidal osteoma. We treated her with two injections of 1.25 mg/0.05 mL IVB with a 4-month interval.Results:The patient’s VA in her left eye improved to 0.7, and this vision was maintained for 4 years. The CNV disappeared in the FA and ICGA images and no recurrence was observed after 4 years.Conclusion:Our findings indicate that IVB is effective in resolving CNV in eyes with an osteoma and prevents a decrease of vision in eyes with a choroidal osteoma with a CNV.

Long-term results of intravitreal ranibizumab for osteoma-related choroidal neovascularization in a child

“…recently reported successful treatment of CNV associated with choroidal osteoma with two intravitreal injections of bevacizumab in a 12-year-old girl and no recurrence till a follow-up of four years. [8] In pediatric population, as reported by Avery et al .,[9] use of ranibizumab instead of bevacizumab may lower systemic exposure given its much shorter serum half-life and as found in several animal studies. There is a recent report of intravitreal ranibizumab use in an 11-year child for CNV associated with choroidal osteoma.…”

De Novo Appearance of a Choroidal Osteoma in an Eye With Previous Branch Retinal Vein Occlusion

“…9-12 These tumors are generally slow growing, leading to a slow but progressive decrease in vision. 2 In a follow-up study of 36 patients, the probability of loss of visual acuity (20/200 or worse) was more than 50% by 10 years. 12 CNV is the most frequent cause of visual impairment in choroidal osteoma.…”

“…1-3 The most striking feature of this rare entity is a slightly elevated well-defined mass, which is yellowish orange in appearance, as characteristically observed on ophthalmoscopic examination. 2,4 There may be variation in color due to depigmentation, hyperplasia or thinning of the overlying retinal pigment epithelium (RPE). 1 …”

Review of choroidal osteomas

“…Others required the adjunct use of additional modalities such as PDT or TTT 3262. These results were maintained over an average of 12 months of follow up, some up to 4 years 59. The favorable visual outcome following bevacizumab or ranibizumab injections is credited to the decrease in VEGF which, even at physiologic levels, might reduce the permeability of choroidal vessels 32.…”

“…The favorable visual outcome following bevacizumab or ranibizumab injections is credited to the decrease in VEGF which, even at physiologic levels, might reduce the permeability of choroidal vessels 32. It has also been estimated that VEGF is up regulated secondary to chronic inflammation and mild ischemia caused by the choroidal tumor 59. Also the good results may be attributed to better drug availability through improved penetration of a thinned and degenerated RPE55 [Table 2].…”