Review of choroidal osteomas

Abstract

Choroidal osteomas are rare benign ossifying tumors that appear as irregular slightly elevated, yellow-white, juxtapapillary, choroidal mass with well-defined geographic borders, depigmentation of the overlying pigment epithelium; and with multiple small vascular networks on the tumor surface. Visual loss results from three mechanisms: Atrophy of the retinal pigment epithelium overlying a decalcified osteoma; serous retinal detachment over the osteoma from decompensated retinal pigment epithelium, and most commonly from choroidal neovascularization. Recent evidence points to the beneficial effects of intravitreal vascular endothelial growth factor antagonists in improving visual acuity in serous retinal detachment with or without choroidal neovascularization.

Keywords: Argon Laser; Choroidal Osteoma; Intravitreal Bevacizumab; Intravitreal Ranibizumab; Photodynamic Therapy.

Figure 1

Right fundus photograph showing a posterior pole choroidal osteoma involving the macula with overlying atrophy of the retina and choroid (Courtesy of Dr Sami Uwaydat, University of Arkansas)

Figure 2

Left fundus photograph showing a peripapillary and inferior arcade choroidal osteoma sparing the fovea. Patient had bilateral choroidal osteomas with the right fundus depicted in Figure 1 (Courtesy of Dr Sami Uwaydat, University of Arkansas)

Figure 3

Fundus photograph of the left eye with superior peripapillary and macular choroidal osteoma with associated CNV. Before the anti-VEGF era, this patient had multiple argon laser treatments with recurrence of the membranes (Courtesy of Dr Sami Uwaydat, University of Arkansas)

Figure 4

Left peripapillary extrafoveal osteoma of the choroid measures 3 by 2 disc diameters and is associated with subfoveal CNV that responded to 2 consecutive intravitreal bevacizumab injections with visual improvement over one year of follow-up. B-scan, OCT and fluorescein angiography transits are shown in Figures 7-9 (Courtesy of Dr Eman Al Kahtani, King Khaled Eye Specialist Hospital)

Figure 5

B-scan demonstrates focal subretinal calcification from 2:00 to 3:00 o'clock next to the optic disc. (Courtesy of Dr Eman Al Kahtani, King Khaled Eye Specialist Hospital)

Figure 6

Fluorescein angiography 35-second transit reveals dye leakage in the foveal region (CNV) and dye staining in the area of chronic RPE decompensation overlying the choroidal osteoma at 1 o'clock near the peripapillary area (Courtesy of Dr Eman Al Kahtani, King Khaled Eye Specialist Hospital)