Bilateral multifocal choroidal osteoma with choroidal neovascular membrane

Abstract

A healthy 32-year-old woman presented at Aravind Eye Hospital, Pondicherry, with gradual vision loss in her right eye (20/80) of 1 year’s duration. Fundus examination of the right eye showed two discrete yellowish-white subretinal lesions in the peripapillary area (A), pigmentary changes of the macula, and a dull foveal reflex. The fundus examination of the asymptomatic left eye showed a similar B-scan ultrasonography revealed hypereflectivity at the choroidal level that corresponded to the lesions, with back shadowing confirming the lesions’ calcific nature, suggestive of bilateral, multifocal choroidal osteoma (A-B, inset). Optical coherence tomography showed a choroidal neovascular membrane (CNVM), with intraretinal fluid in the right eye (C) and a dry macula in left eye (D). Investigations for secondary causes of the calcific deposits were negative, including calcium levels, thyroid profile, and blood counts. The patient received 2 doses of intravitreal bevacizumab. Following treatment, the CNVM remained inactive over 12 months’ follow-up (E and G). The left eye macula remained dry throughout the course of the disease (F and H).