Faricimab for choroidal neovascular membrane secondary to choroidal osteoma: A case report

Choroidal osteoma is a rare, benign ossifying tumor of the choroid. As the disease progresses, significant visual loss may occur. Approximately one-third of patients with choroidal osteoma develop a choroidal neovascular membrane. Choroidal neovascular membrane-associated exudation and photoreceptor disruption can lead to progressive visual decline. However, no established standard treatment exists, particularly for choroidal neovascular membrane secondary to choroidal osteoma. A healthy male in his 30s with known bilateral choroidal osteomas presented with metamorphopsia and decreased vision in his left eye. Intraretinal fluid and subretinal fluid were detected on optical coherence tomography, and an active choroidal neovascular membrane was identified on optical coherence tomography angiography. Despite monthly intravitreal anti-vascular endothelial growth factor injections of ranibizumab and aflibercept, both intraretinal fluid and subretinal fluid persisted. The treatment was therefore switched to intravitreal faricimab, resulting in complete resolution of intraretinal fluid and subretinal fluid. Furthermore, the treatment interval was successfully extended to 16 weeks without recurrence. This case suggests that faricimab may be a viable therapeutic option for choroidal osteoma secondary to choroidal neovascular membrane in selected patients. However, further studies are warranted to confirm its efficacy, durability, and safety.