PMC3151569_01
Patient with a choroidal osteoma and choroidal neovascularization before treatment. (A) Fundus photograph showing 5-disc-diameter hemorrhage under the retinal pigment epithelium. (B) Horizontal optical coherence tomographic image, showing pigment epithelial detachment and serous retinal detachment. (C, D) Angiography: fluorescein angiography (C) and indocyanine angiography (D) show several points of dye leakage around the fovea.
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Ophthalmoscopy showed a 5-disc diameter hemorrhage under the retinal pigment epithelium (RPE) and serous retinal detachment (SRD) at the posterior pole of the left eye (Figure 1A). These findings were confirmed by optic coherence tomography (OCT) (Figure 1B). Fluorescein angiography (FA) showed a mild pooling of dye associated with a pigment epithelium detachment and several points of leakage superior and inferior to the fovea (Figure 1C). Indocyanine green angiography (ICGA) showed leakage lateral and inferior to the fovea, which suggested a CNV (Figure 1D).
(A) Computed tomographic images of patient with choroidal osteoma, showing calcification and bone-density mass in the posterior pole of the left eye. (B) Ultrasonic echography (B-mode) shows a convex elevation in the posterior pole of the eye, producing an acoustic shadow behind the sclera.
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CT showed calcification and a bone-density mass in the posterior pole of the left eye (Figure 2A), but magnetic resonance imaging showed no unusual changes in the intra- and extraocular areas. Ultrasound echography (B-mode) showed a flat convex elevation in the posterior pole of the eye, which produced an acoustic shadow behind the sclera (Figure 2B).
Patient with a choroidal osteoma and choroidal neovascularization 18 months after two intravitreal injections of bevacizumab. Fundus photograph (A), horizontal optical coherence tomographic scan (B), fluorescein angiography indocyanine angiography (C), and indocyanine angiography (D) all show absence of subretinal fluid and leakage points.
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We gave a second IVB injection 4 months after the first treatment, the CNV disappeared, and no recurrence has been observed (Figure 3).
Microperimetric findings. Findings before (A) and 3 years after (B) two intravitreal injections of bevacizumab. Fixation indicated by small blue dots is improved.
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Microperimetry showed poor sensitivity with poor focus and fixation (Figure 4A). The patient was followed for 4 years, and microperimetry showed that the average sensitivities improved from 8.0 dB before, to 6.0 dB at 4 months, 4.8 dB at 6 months, and 10.0 dB at 42 months after the IVB (Figure 4B).