[Neovascular complications of choroidal osteoma: Diagnosis and treatment]

Choroidal osteoma is a rare benign ocular tumor, with neovascular complications being even less common. The diagnosis is greatly facilitated by multimodal imaging techniques. However, treatment remains a challenge, as no standardized protocols exist, and current approaches rely primarily on intravitreal injections of anti-VEGF agents.

We describe the case of a 45-year-old patient with no significant medical history who presented in 2020 with a progressive macular syndrome, characterized by decreased visual acuity and a central scotoma over several months. Ophthalmologic examination of the right eye was unremarkable, while the left eye showed reduced visual acuity of 3/10. The anterior segment was normal with a clear lens. Fundoscopy revealed a well-demarcated yellowish juxta-papillary subretinal lesion extending into the papillomacular area. Optical coherence tomography (OCT) demonstrated serous retinal detachment, intraretinal macular edema, and retinal pigment epithelial (RPE) detachments, along with a juxta-papillary eovascular membrane. A-scan ultrasonography confirmed the diagnosis of choroidal osteoma, showing a hyper-echogenic lesion with posterior shadowing. Retinal angiography and indocyanine green angiography (ICG) revealed occult neovascularization extending into the papillomacular area. The patient was treated with intravitreal anti-VEGF injections. Although the therapeutic response was gradual, injections every six weeks successfully maintained visual acuity at 7/10 and resolved the intra- and subretinal fluid.

The management of neovascular complications in choroidal osteoma remains complex due to the absence of standardized treatment protocols. Anti-VEGF therapy shows promise, albeit with a slow response, and requires sustained long-term administration to optimize visual outcomes and preserve visual function.