Combination therapy of low-fluence photodynamic therapy and intravitreal ranibizumab for choroidal neovascular membrane in choroidal osteoma

Abstract

Choroidal osteoma is an unusual form of intraocular calcification seen in otherwise healthy eyes. It is a benign idiopathic osseous tumor of the choroid, typically seen in young females. Choroidal neovascular membrane (CNVM) is a complication seen in one-third of these patients and carries a poor visual outcome. We report a case of a 25-year-old hyperthyroid female with choroidal osteoma and subfoveal CNVM in her left eye which was successfully treated using low-fluence photodynamic therapy (PDT) with verteporfin followed by a single injection of intravitreal ranibizumab.

Figure 1

(a) Fundus photograph of the left eye showing yellowishorange lesion with scalloped margins and pseudopod borders and subretinal hemorrhage in fovea. (b) Late phase angiography shows intense leakage of the dye and blocked fluorescence from hemorrhage suggestive of CNVM. (c) Oblique OCT scan showing subfoveal hyperreflectivity in the RPE layer with the fluid suggestive of CNVM

Figure 2

Ultrasound B-scan showing hyperreflective mass lesion in the posterior pole (white arrow) with aftershadowing of orbital soft tissue posterior to it (black arrow) suggestive of choroidal osteoma

Figure 3

(a) Fundus photograph of the same eye showing absorbed hemorrhage and resolved CNVM posttreatment. (b) Late phase angiogram showing an absence of leakage and staining of scar tissue posttreatment. (c) Oblique OCT scan suggesting hyperreflectivity in the RPE layer and the absence of the fluid indicating scarred CNVM posttreatment

Figure 4

(a) 15-month follow-up FFA showing scarred, inactive CNVM. (b) Horizontal transverse OCT scan showing scarred CNVM with normal foveal contour and absence of the fluid