OSLI Retina

June 2019

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398 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ I M A G E S I N O P H T H A L M O L O G Y ■ Bilateral Choroidal Osteoma Complicated by Bilateral Choroidal Neovascularization Alessandro Arrigo, MD; Luisa Pierro, MD; Riccardo Sacconi, MD, FEBO; Giuseppe Querques, MD, PhD; Francesco Bandello, MD, FEBO ABSTRACT: Choroidal osteoma is a rare, classically unilateral tumor. Less than half of the cases are complicated by the onset of choroidal neovascular- ization (CNV). The authors describe a case of bi- lateral choroidal osteoma in a 10-year-old female patient complicated by the onset of bilateral CNV. The diagnosis was made by multimodal imaging and ultrasonography. Best-corrected visual acuity (BCVA) was 20/63 for the right eye (OD) and 20/25 for the left eye (OS). Interestingly, CNV OD resulted exudative, whereas no signs of fluid were detected OS. OCT angiography (OCTA) clearly detected the presence of CNV in both eyes. The patient under- went a single 1.0 mg/0.025 mL aflibercept injec- tion OD. At follow-up, BCVA improved to 20/32 OD after 1 month and to 20/25 after 3 months, with no exudation recurrence. Both BCVA and imaging findings were unremarkable OS, thus suggesting the possible "quiescent" nature of this CNV. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:398-400.] Choroidal osteoma is a rare, benign, often unilat- eral tumor characterized by the growth of cancellous bone involving the choroid. 1 The diagnosis is mainly clinical; multimodal imaging and ultrasonography provide useful information for the diagnosis. We present a case of a young female patient (10 years old) complaining of bilateral visual acuity (VA) reduction (right eye [OD] > left eye [OS]). Best-cor- rected VA (BCVA) was 20/63 for OD and 20/25 for OS. Fundus examination revealed bilateral, almost symmetric, round orange-yellow lesion involving the entire posterior pole and the papillary area (Figures 1A and 1B), suggestive of choroidal osteomas. Macu- lar retinal hemorrhage was found OD. Ultrasonogra- phy B-scan examination showed bilateral, slightly el- evated, hyperechogenic lesion, with posterior sound attenuation typical of choroidal osteomas (Figures 1A and 1B). Structural optical coherence tomogra- phy (OCT) showed the presence of a big, subfoveal, mainly hyperreflective lesion with posterior shadow effect OD combined with subretinal exudation, atro- phy of external retinal layers at the borders of the le- sion, and the loss of physiologic foveal profile (Figure 1C). Little subfoveal hyperreflective accumulation From the Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy. Originally submitted August 17, 2018. Revision received August 17, 2018. Accepted for publication November 6, 2018. The PLEX Elite 9000 has been made available through the Advanced Retina Imaging Network, for which Dr. Querques is a steering committee member. Dr. Querques has received personal fees from Alimera Sciences, Allergan, Bayer Shering-Pharma, Heidelberg, Novartis, Sandoz, and Zeiss outside the submitted work. Dr. Bandello has received personal fees from Alcon, Alimera Sciences, Allergan, Farmila-Thea, Bayer Shering-Pharma, Bausch + Lomb, Ge- nentech, Hoffmann-La-Roche, Novagali Pharma, Novartis, Sanofi-Aventis, Thrombogenics, and Zeiss outside the submitted work. The remaining authors report no relevant financial disclosures. Address correspondence to Giuseppe Querques MD, PhD, Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olget- tina 60, Milan, Italy 20132; email: giuseppe.querques@hotmail.it. doi: 10.3928/23258160-20190605-10

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