Indian Journal of Ophthalmology

BRIEF REPORT
Year
: 2004  |  Volume : 52  |  Issue : 4  |  Page : 329--30

Choroidal neovascular membrane associated with choroidal osteoma (CO) treated with trans-pupillary thermo therapy.


S Sharma, N Sribhargava, Mahesh P Shanmugam 
 Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India

Correspondence Address:
S Sharma
Medical and Vision Research Foundation, Sankara Nethralaya, Chennai
India

Abstract

Choroidal neovascular membrane, a known complication of choroidal osteoma causing visual loss when located subfoveally, can be successfully treated with transpupillary thermo therapy.



How to cite this article:
Sharma S, Sribhargava N, Shanmugam MP. Choroidal neovascular membrane associated with choroidal osteoma (CO) treated with trans-pupillary thermo therapy. Indian J Ophthalmol 2004;52:329-30


How to cite this URL:
Sharma S, Sribhargava N, Shanmugam MP. Choroidal neovascular membrane associated with choroidal osteoma (CO) treated with trans-pupillary thermo therapy. Indian J Ophthalmol [serial online] 2004 [cited 2022 Jul 2 ];52:329-30
Available from: https://www.ijo.in/text.asp?2004/52/4/329/14558


Full Text

Choroidal osteoma, a benign ossifying tumour of the choroid is seen in healthy young females in the second to third decade of life.[1] It is seen in the juxtapapillary choroid either as a unilateral tumour or bilaterally in as many as 25 % of cases.[2]. Choroidal neovascularisation is one of the major complications of this condition leading to visual loss [1],[2],[3]

We report a case of a young Indian female patient with bilateral choroidal osteoma and a choroidal neovascular membrane (CNVM) in one eye. This was treated with transpupillary thermo therapy (TTT) successfully. A detailed Medline search was performed and to the best of our knowledge, this is the first such case reported in literature.

 Case report



A 32-year-old lady presented with acute decrease in vision in the right eye of a month's duration. Her best-corrected visual acuity was 6/24; N 18 in the right eye and 6/6; N6 in the left eye. Anterior segment examination of both eyes was within normal limits. Fundus examination of both eyes showed a circumscribed juxtapapillary yellow-white lesion involving the macula, with orange borders and depigmentation of the retinal pigment epithelium suggestive of choroidal osteoma. A grey subfoveal neovascular membrane with surrounding subretinal haemorrhage, pigmentation and minimal subretinal fluid, was seen in the right eye [Figure 1]a

Fundus fluorescein angiography confirmed the presence of classic subfoveal CNVM in the right eye [Figure 1] b,c,d. Ultrasonography confirmed the clinical diagnosis of the choroidal osteoma in both eyes [Figure 1]e.

Considering the location of the CNVM and its classic nature, she was advised to undergo photodynamic Therapy (PDT). Due to financial constraints, she did not prefer PDT and decided to undergo TTT, which was offered as an alternative treatment. TTT was done in the right eye (total energy 52 mJ; power 400 mWatts; exposure time 1 min; 1 burn; spot size 3 mm).

When reviewed 3 months later, her best corrected visual acuity in the right eye had improved to 6/18; N18. Fundus examination showed a scarred CNVM, which was confirmed on FFA. [Figure 2]a-d) She maintained her vision ten months after treatment with a scarred CNVM.

 Discussion



CNVM has been described as a complication in more than half the reported eyes with choroidal osteoma.[3] The estimated probability of developing CNVM in choroidal osteoma is 0.53 at 10 years and 0.44 at 20 years.[2] The visual acuity in the eye affected with choroidal osteoma often is surprisingly good, even when the tumour is in a subfoveal or peripapillary location.[4] The development of CNVM is one of the major causes of decrease in vision. [1],[2],[3]

Photodynamic therapy is now increasingly used to treat CNVM due to other causes like myopia and secondary to posterior uveitis. It has been used successfully to close extrafoveal CNVM associated with choroidal osteoma.[5]

Laser photocoagulation of CNVM in choroidal osteoma has been reported, [1],[2],[3]with contrasting results. The limited success rate seen may be ascribed to the depigmentation of the retinal pigment epithelium (RPE) underlying the choroidal osteoma and the thinned and degenerated RPE-Bruchs membrane complex, which would lessen the energy absorption necessary to close the CNVM. [1],[2],[3]The subfoveal location of the CNVM also would limit the use of the as the modality of treatment.

Large subfoveal lesions of age-related macular degeneration have been treated with TTT with preservation of good visual acuity in both occult and classic CNVMs.[6] The role of TTT in CNVMs of other aetiologies is not reported. To the best of our knowledge, this is the first time that TTT has been used successfully to treat CNVM and maintain good visual acuity in a patient of choroidal osteoma. This may be better than using laser photocoagulation which could cause decrease in vision.

References

1Shields CL, Shields JA, Augsburg JJ. Choroidal osteoma. Surv Ophthalmol 1988;33:17-27.
2Aylward GW, Chang TS, Pautler SE, Gass JDM. A long-term follow-up of choroidal osteoma. Arch Ophthalmol 1998;116:1337-41.
3Lopez PF, Green WR. Peripapillary dubretinal neovascularization; A review. Retina 1992;12:147-71.
4Shields JA, Shields CL, Ellis J, DePotter P. Bilateral choroidal osteoma associated with bilateral total blindness. Retina 1996;16:445-47.
5Battaglia Parodi M, Da Pozzo S, Toto L, Saviano S, Ravalico G. Photodynamic therapy for choroidal neovascularization associated with choroidal osteoma. Retina 2001;21:660-61.
6Miller-Rivero NE, Kaplan HJ. Transpupillary thermo therapy in the treatment of occult and classic choroidal neovascularization. Invest Ophthalmol Vis Sci 2000;41:S 179.