Multimodal Imaging of Choroidal Neovascularization Associated with Sclerochoroidal Calcification

Abstract

We report a case of a choroidal neovascular membrane (CNVM) associated with sclerochoroidal calcification (SCC). An asymptomatic, 72-year-old male was referred to our institution for yellow-white placoid retinal lesions of both eyes. B-scan ultrasonography confirmed the diagnosis of SCC, and indocyanine green angiography confirmed the presence of an associated CNVM. Due to enlargement of a hemorrhagic pigment epithelial detachment associated with the CNVM over the course of 7 months, the patient was treated with a series of bevacizumab injections followed by photodynamic therapy (PDT). Due to persistence of the CNVM following PDT, the lesion was finally treated with argon laser photocoagulation. We describe the clinical course of this rare complication of SCC.

A Case of Extensive Bilateral Idiopathic Sclerochoroidal Calcification and Review of Literature

“…7 Rarely, visual deterioration is seen in SCC due to the development of choroidal neovascularization (CNV) with exudation extending to the macula. 8,9 The differential includes choroidal metastasis, melanoma, nevus, osteoma, chorioretinitis, and intraocular lymphoma which may be differentiated upon exam, imaging, and angiography. 4 SCC findings on multimodal imaging are summarized in Table 2.…”

“…• Radiodense scleral lesion(s) due to presence of calcium Notes: Data from these studies [3][4][5][6][7][8][10][11][12]…”

Choroidal neovascularization complicating sclerochoroidal calcifications

“… 1 , 2 , 3 , 4 , 5 , 6 CNV may complicate the course of SCC, showing variable clinical outcomes. 3 , 5 , 7 , 8 , 9 , 10 , 11 When the CNV is asymptomatic and distant from the fovea, no treatment may be required, a frequent monitoring being sufficient to ascertain the stabilization of the CNV. 5 , 7 On the other hand, several treatment modalities are available when CNV showed exudative manifestations, including laser photocoagulation, photodynamic therapy and anti-VEGF injections.…”

“…5 , 7 On the other hand, several treatment modalities are available when CNV showed exudative manifestations, including laser photocoagulation, photodynamic therapy and anti-VEGF injections. 7 , 8 , 9 , 10 , 11 , 12 Intravitreal anti-VEGF treatment was used to stabilize the SCC-related CNV activity in a few cases, with variable results. 10 , 11 , 12 In particular, in a single case, a series of bevacizumab injections failed to control the CNV-related retinal exudation, 11 whereas in another case the macular edema and subretinal fluid was reduced after an unspecified number of intravitreal anti-VEGF injections in combination with a single posterior subtenon injection of triamcinolone acetonide.…”

Enlargement of Sclerochoroidal Calcifications: Multimodal Imaging Update

“…Given the possibility for enlargement of these lesions and the rare development of choroidal neovascularization associated with these calcifications, 9 we recommend regular follow-up and imaging every couple years.…”