Optical Coherence Tomography Features and Multimodal Imaging Findings in Choroidal Osteoma: A Case Series

The aim of this study was to characterize optical coherence tomography (OCT) findings in choroidal osteoma and evaluate their associations with subretinal fluid, choroidal neovascularization, and structural retinal changes.

This retrospective descriptive case series included 7 patients (10 eyes) with choroidal osteoma evaluated at a tertiary referral center. All eyes underwent comprehensive ophthalmologic examination and spectral-domain OCT imaging. OCT scans were analyzed for predefined structural features, including hyperreflective lamellar patterns, spongiform appearance, outer retinal alterations, and subretinal fluid. Subretinal fluid was classified as neovascular or non-neovascular based on OCT characteristics.

OCT revealed marked structural heterogeneity. Three eyes demonstrated isolated subretinal fluid without neovascular features, resolving spontaneously in two cases. Three eyes showed chronic subretinal fluid or intraretinal cystic changes with neovascular OCT features and responded favorably to repeated intravitreal anti-vascular endothelial growth factor therapy. One eye with long-term follow-up exhibited progressive tumor decalcification with severe retinal and choroidal thinning and poor visual outcome. Focal choroidal excavation was identified in one eye in association with choroidal neovascularization.

Choroidal osteoma exhibits heterogeneous OCT patterns reflecting different mechanisms of visual impairment. Careful OCT-based assessment may aid differentiation of neovascular and non-neovascular changes and guide clinical management.