Rare Complication of Sclerochoroidal Calcifications

Abstract

A 75-year-old woman of white race/ethnicity was referred for bilateral choroidal lesions. She described her vision as being blurred in the left eye, with areas of her vision being "blocked." Her review of systems was unremarkable. Her medical and ocular histories were significant for pseudophakia of both eyes, obstructive sleep apnea, and hypertension treated with hydrochlorothiazide.On examination, visual acuity was 20/40 OD and 20/64 OS. Intraocular pressure, pupillary reaction, and ocular motility were normal. Confrontation visual fields revealed a deficit in the inferotemporal quadrant of the left eye. External and slitlamp examinations were unremarkable. Dilated fundus examination revealed an epiretinal membrane, as well as extramacular, elevated, hypopigmented, yellow lesions with retinal pigment epithelium changes in both eyes, along with overlying subretinal fluid, subretinal hemorrhage, and exudates in the left eye (Figure , A). Optical coherence tomography showed an epiretinal membrane with cystoid macular edema and drusen in both eyes, along with subretinal fluid extending into the left macula, explaining her decreased vision. B-scan ultrasonography demonstrated hyperechoic, plaquelike, solid lesions with posterior acoustic shadowing corresponding anatomically to the lesions seen on clinical examination (Figure , B). Fluorescein and indocyanine angiography demonstrated leakage in the area of subretinal hemorrhage in the left eye (Figure , C). Diagnosis Sclerochoroidal calcifications with secondary choroidal neovascularizationWhat to Do Next C. Check parathyroid hormone, vitamin D, and calcium levels Discussion

Choroidal neovascularization complicating sclerochoroidal calcifications

“…Nevertheless, CNV seems to complicate the course of SCC in advanced age, since all the described cases are above 70. 7 , 8 , 9 , 10 , 11 , 12 OCT angiography in one case demonstrated choroidal ischemia in the area of SCC and it is possible that the choroidal hypoperfusion or RPE compression by SCC can lead to CNV formation. 13 Of interest is the close similarity between CNV in choroidal osteoma and CNV in SCC, knowing that up to half of eyes with choroidal osteoma can develop CNV and are best treated with 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.…”

“… 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. 12 Our experience in two consecutive patients affected by CNV secondary to SCC suggests that intravitreal ranibizumab can achieve positive functional and anatomical outcomes over a six-year follow-up.…”

“…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. 12 Our experience in two consecutive patients affected by CNV secondary to SCC suggests that intravitreal ranibizumab can achieve positive functional and anatomical outcomes over a six-year follow-up. Interestingly, a single injection was not enough to promote the CNV stabilization, being necessary to administer 3 and 9 injections respectively, over a six-year follow-up.…”