OSLI Retina

January/February 2013

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■ C A S E De Novo Appearance of a Choroidal Osteoma in an Eye With Previous Branch Retinal Vein Occlusion Mehreen Adhi, MBBS; Juanita Sonya Bryant, MD; Ahmad A. Alwassia, MD; Carolyn Chen, MD; Jay S. Duker, MD ABSTRACT: This report describes the de novo appearance of a choroidal osteoma occurring 8 years after laser photocoagulation for previous branch retinal vein occlusion (BRVO). A 62-year old man presented with an asymptomatic yellowish orange lesion in the macula on fundus examination of his left eye during a regular follow-up visit for bilateral BRVO associated with macular edema that had previously been treated with laser photocoagulation. The lesion was observed for 1.5 years until a decrease in vision occurred. Fundus photography revealed a yellow-toorange, well-defined lesion in the macular region. Fluorescein angiography was consistent with choroidal neovascularization (CNV). Optical coherence tomography and B-scan ultrasonography showed features consistent with choroidal osteoma. This is the first report of the de novo appearance of a choroidal osteoma occurring years after laser photocoagulation for BRVO. CNV developed secondary to the lesion, which was treated with intravitreal bevacizumab, leading to subjective and anatomic improvement. [Ophthalmic Surg Lasers Imaging Retina 2013;44:77-80.] From the New England Eye Center, Tufts Medical Center, Boston, Massachusetts. Originally submitted August 20, 2012. Accepted for publication November 13, 2012. Supported in part by a Research to Prevent Blindness unrestricted grant to the New England Eye Center/Department of Ophthalmology, Tufts University School of Medicine; NIH contracts RO1-EY11289-23, R01-EY13178-07, and R01-EY013516-07; Air Force Office of Scientific Research FA9550-07-1-0101 and FA9550-07-1-0014; and the Massachusetts Lions Eye Research Fund. Dr. Duker receives research support from Carl Zeiss Meditec, Inc., Optovue, Inc., and Topcon Medical Systems, Inc. The remaining authors have no financial or proprietary interest in the materials presented herein. Dr. Duker did not participate in the editorial review of this manuscript. Address correspondence to Jay S. Duker, MD, New England Eye Center, Tufts Medical Center, 800 Washington Street, Boston, MA 02111. E-mail: Jduker@tuftsmedicalcenter.org. doi: 10.3928/23258160-20121221-17 Ophthalmic Surgery, Lasers & Imaging Retina · Vol. 44, No. 1, 2013 R E P O R T ■ INTRODUCTION Choroidal osteoma is a rare, benign ossifying tumor, typically presenting in the juxtapapillary region in young healthy females with no history of systemic or ocular disease in their second or third decade of life.1-3 The most striking feature of this rare entity is a slightly elevated, well-defined mass, which is yellowish orange in appearance, as characteristically observed on ophthalmoscopic examination.2,4 There may be variation in color due to depigmentation, hyperplasia, or thinning of the overlying retinal pigment epithelium (RPE).1 Choroidal osteoma has been reported to rarely present in association with pregnancy and in eyes with a history of ocular diseases such as optic atrophy, optic neuritis in Behçet's disease, retinitis pigmentosa, Stargardt's disease, and bilateral optic nerve sheath calcification.3,5-9 To the best of our knowledge, it has never been shown to present in an eye with previous BRVO. This report describes the de novo appearance of choroidal osteoma occurring years after laser photocoagulation for BRVO. CASE REPORT A 62-year-old Asian man with a known history of diabetes mellitus, hypertension, and asthma presented in April 2009 at the New England Eye Center, Tufts Medical Center, Boston, with an asymptomatic yellowish orange lesion on fundus examination of his left eye during a regular follow-up visit for bilateral branch retinal vein occlusion (BRVO). He had a history of BRVO with macular edema for 10 years in the right eye and 8 years in the left eye that had been successfully treated with sectoral panretinal photocoagulation (PRP) and focal laser bilaterally (Fig. 1). For the past 6 years, he had maintained stable vision of 20/100 in the right eye and 20/30 in the left eye. At the time of presentation, his best-corrected visual acuity (BCVA) was 20/200 in the right eye and 20/30 in the left eye. On dilated fundus examination, both eyes showed areas of sectoral PRP, sclerotic vessels in the periphery, and scarring with subretinal fibrosis, owing to the history of laser photocoagulation for BRVO. However, fundus photography of the left eye revealed a well-circumscribed yellowish orange lesion in the macular region, while optical coherence tomography (OCT) showed a slight disruption of the RPE (Fig. 2). The lesion was observed on follow-up visits. 77

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