Choroidal osteoma: observations from a community setting.

Abstract

To determine the characteristics of choroidal osteoma arising from a previously unreported patient population and to document new observations in this condition. Retrospective, observational case series. Eleven consecutive patients seen from 1986 through 2002 with choroidal osteoma from one community-based retina practice. Laser ablation of subretinal neovascularization in two cases and focal laser treatment of retinal pigment epithelial leaks in one case. Photographs, fluorescein and indocyanine green angiograms, and clinical records were analyzed. Demographic variables, visual acuity, complications of laser treatment, growth of lesions, and associated funduscopic changes. Choroidal osteoma from a community setting is more frequently asymptomatic (5/11 cases; 45%) than in previously reported university series, is usually initially misdiagnosed, and is not rare. Light-intensity focal laser photocoagulation for serous retinal detachment unaccompanied by subretinal neovascularization can resolve fluid (1/11 cases; 9%). Laser ablation of secondary subretinal neovascularization stimulates rapid choroidal osteoma vascular remodeling (2/11 cases; 18%) and can cause retina-osteoma venous and arterial anastomoses (1/11 cases; 9%). Spontaneous choroidal hemorrhage unaccompanied by subretinal neovascularization can occur with confinement to the osteoma borders (1/11 cases; 9%). Association of choroidal osteoma with retinitis pigmentosa is reported. These data on choroidal osteoma natural history and treatment help clinicians managing these lesions. In the community, a higher index of suspicion for choroidal osteoma is warranted.