Francisco J. Ascaso, Laura Villén, Valentín Huerva, Javier Mateo, María A. Del Buey (Zaragoza, Spain)

Advantages:

Choroidal osteoma (CO), typically found in healthy young women, is a rare benign intraocular tumor composed of mature cancellous bone replacing the full thickness of the choroid. Vision loss in CO depends on tumor location, serous retinal detachment (RD) associated or not, the presence of choroidal neovascularization (CNV), overlying retinal pigment epithelium alteration, and photoreceptor degeneration. The management of CO is a challenging issue. Several treatments such as laser photocoagulation, surgical removal of CNV, transpupillary thermotherapy (TTT), and photodynamic therapy (PDT) have been tried with limited success. Recently, anti-VEGF agents have been reported to decrease vascular permeability in a few cases of CO.

Methods:

We present the case of a 12-year-old girl complaining of acute decrease in vision in her right eye. Best-corrected visual acuity was 20/400 in her right eye and 20/20 in her left eye. Fundus examination revealed a circumscribed, slightly elevated juxtapapillary yellow-white lesion involving the macula, suggestive of CO. Ultrasonography and computed tomography (CT) showed a characteristic, well defined, homogeneously radio-opaque plaque of bone density in the posterior wall of the right eyeball in conjunction with a highly elevated serous macular detachment compatible with retinoschisis. Considering tumor location, the patient underwent intravitreal ranibizumab injection without any complications. Retreatment was performed at 2 months because of serous RD persistence. Despite intravitreal ranibizumab injections neither visual acuity nor RD improved.

Effectiveness / Safety:

Several authors have proposed that intravitreal anti-VEGF agents may be a useful and safe treatment in subretinal fluid (SRF) secondary to CO. However, in this patient, no beneficial effect of intravitreal ranibizumab was evident in both anatomical and functional improvement. Long-term follow-up and further studies are required to confirm the role of anti-VEGF therapy to manage of SRF associated with CO.

Take home message:

Intravitreal ranibizumab is not always useful to treat serous macular detachment associated to CO.