Purpose: To report a pediatric case of choroidal osteoma with rapid expansion and choroidal neovascularization (CNV), which were treated by intravitreal administration of bevacizumab.
Case: A girl aged 6 years and 8 months presented at a local physician after being told at a school examination that her left eye had poor visual acuity. She did not respond to the treatment administered for improving visual acuity and was referred to Inoue Eye Hospital. Visual acuity in the left eye was 0.9 (n. c.) on her first visit. An orange-red circular lesion adjacent to the optic disc and multiple pigmented spots in the macula were observed in the posterior pole of the left eye. Optical coherence tomography revealed serous retinal detachment (SRD) and choroidal protrusion in the macula. B-mode ultrasonography showed a high reflection image at the site of the tumor and absorption attenuation image of the retrobulbar tissue, based on which the patient was diagnosed with choroidal osteoma. The tumor had enlarged after 11 months, but SRD had disappeared. However, subretinal hemorrhage (SRH) and SRD reoccurred after 2 years, and visual acuity in the left eye decreased to 0.5. CNV was diagnosed by performing fundus fluorescein angiography. Administering a vitreous injection of bevacizumab led to the disappearance of SRD and reduction of SRH. Owing to the recurrence of SRD, a second intravitreal injection of bevacizumab was administered after 4 months. No subsequent recurrence was observed, but visual acuity in the left eye remained 0.3. The tumor showed a rapid growth rate of 2.22 mm/year during the 4-year follow-up period and is still expanding vertically.
Conclusions: Choroidal osteoma in a patient with CNV was successfully treated by administering intravitreal anti-vascular endothelial growth factor (VEGF) therapy. The onset of choroidal osteoma occurred at a young age, and the tumor is still rapidly expanding. Further follow-up is required.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 127: 689-696,2023.