Mercé E, Korobelnik J-F, Delyfer M-N, Rougier M-B
Service d'Ophtalmologie, CHU Dupuytren, 4, avenue Martin-Luther-King, 87042 Limoges, France.
J Fr Ophtalmol. 2012 Sep;35(7):508-13. doi: 10.1016/j.jfo.2011.11.009. Epub 2012 Jun 12.
Choroidal osteoma is a rare, ossifying tumor, which, while benign, may be complicated by choroidal neovascularization.
An 11-year-old boy presented with blurred vision in the right eye for few days. Fundus examination showed bulky lesion in the posterior pole containing a sub-retinal hemorrhage. The geographic borders and color of the mass were typical of choroidal osteoma despite the unusual macular location. The diagnosis was confirmed by ultrasonography. The patient was treated with three successive intravitreal injections of 1.25 mg/0.05 mL bevacizumab (IVB) under general anesthesia, due to recurrences of neovascular activity. SD-OCT in EDI mode was carried out prior to each injection.
SD-OCT before and after each bevacizumab injection confirmed regression of serous retinal detachment (SRD) at various locations throughout the lesion, especially in the hemorrhagic zone. It also allowed us to differentiate the active decalcified zones from the inactive calcified zones and to follow treatment response.
The treatment of choroidal neovascularization (CNV) secondary to choroidal osteoma is not well defined. As for other etiologies of CNV, anti-VEGF agents (such as bevacizumab) appear to be effective in regressing CNV and improving visual function. In our young patient, general anesthesia was necessary to administer each injection. SD-OCT allows diagnostic confirmation and follow-up of treatment. EDI mode is helpful in studying the choroid and the osteoma.
We report a rare case of macular choroidal osteoma, examined by SD-OCT. CNV required several anti-VEGF injections, with good anatomical and functional results.
脉络膜骨瘤是一种罕见的骨化性肿瘤，虽为良性，但可能并发脉络膜新生血管。
一名11岁男孩右眼视物模糊数天。眼底检查显示后极部有一巨大病变，伴有视网膜下出血。尽管该肿物位于黄斑区位置不寻常，但其形态边界和颜色符合脉络膜骨瘤的特征。超声检查确诊了该诊断。由于新生血管活动复发，患者在全身麻醉下接受了3次连续玻璃体腔注射1.25mg/0.05mL贝伐单抗（IVB）治疗。每次注射前均采用增强深度成像（EDI）模式的光谱域光学相干断层扫描（SD - OCT）。
每次贝伐单抗注射前后的SD - OCT证实，病变各处尤其是出血区域的浆液性视网膜脱离（SRD）有所消退。它还使我们能够区分活跃的脱钙区和不活跃的钙化区，并跟踪治疗反应。
脉络膜骨瘤继发脉络膜新生血管（CNV）的治疗尚无明确方案。与其他CNV病因一样，抗血管内皮生长因子（VEGF）药物（如贝伐单抗）似乎对消退CNV和改善视功能有效。在我们的年轻患者中，每次注射都需要全身麻醉。SD - OCT有助于诊断确认和治疗随访。EDI模式有助于研究脉络膜和骨瘤。
我们报告了一例经SD - OCT检查的罕见黄斑脉络膜骨瘤病例。CNV需要多次抗VEGF注射，取得了良好的解剖和功能结果。
