J Korean Ophthalmol Soc.  2018 Oct;59(10):989-994. 10.3341/jkos.2018.59.10.989.

A Case of Choroidal Osteoma with Subretinal Hemorrhage Improved by Intravitreal Bevacizumab and Aflibercept Injections

• Kim C
• Choi KS
• Sun HJ

• KMID: 2422590
• DOI: http://doi.org/10.3341/jkos.2018.59.10.989

Abstract

PURPOSE
To report a case of choroidal osteoma (CO) complicated by extensive subretinal hemorrhage treated with intravitreal bevacizumab and aflibercept injections.
CASE SUMMARY
A 42-year-old female patient presented with decreased visual acuity and a temporal visual field defect in the left eye. The patient had a history of retinal hemorrhage in the left eye 3 years prior, which improved without any treatment. The patient's visual acuity had decreased to 0.6 at the initial visit. On fundus examination, orange-colored elevated lesions involving the superior peripapillary area with massive subretinal hemorrhage extending to the macular area were revealed. Optical coherence tomography, fluorescein angiography, and B-scan ultrasonography results indicated CO complicated by choroidal neovascularization (CNV). With multiple intravitreal injections of bevacizumab and aflibercept (bevacizumab ×1, aflibercept ×2), the patient's visual acuity improved and the CNV lesion was kept stable without recurrence as of the 1-year follow-up visit.
CONCLUSIONS
Intravitreal bevacizumab and aflibercept injections can be helpful in the treatment of CO complicated by CNV, by improving visual acuity and the retinal anatomy.

Keyword

Aflibercept; Bevacizumab; Choroidal osteoma; Subretinal hemorrhage

MeSH Terms

Adult
Bevacizumab*
Choroid*
Choroidal Neovascularization
Female
Fluorescein Angiography
Follow-Up Studies
Hemorrhage*
Humans
Intravitreal Injections
Osteoma*
Recurrence
Retinal Hemorrhage
Retinaldehyde
Tomography, Optical Coherence
Ultrasonography
Visual Acuity
Visual Fields
Bevacizumab
Retinaldehyde

Figure

• 

  Figure 1 Ultrawide fundus photograph (UWFP) of the left eye. UWFP shows a well demarcated, orange-colored elevated lesion involving superior peripapillary area with massive subretinal hemorrhage extending to the macular area (A). Optical coherence tomography shows the well-demarcated mass lesion at the choroidal space above the optic nerve head. Diffuse subretinal fluid with subretinal hemorrhage is seen (B).

• 

  Figure 2 Early fluorescein angiogram (FA) of the left eye. Early FA demonstrates hypofluorescence due to bloackage corresponding to subretinal hemorrhage (A). Late FA of the left eye demonstrates hypofluorescence and hyperfluorescence with leakage at the superior disc area (B).

• 

  Figure 3 B-scan ultrasonography (USG). B-scan USG demonstrates slightly elevated, highly reflective choroidal mass with posterior acoustic shadowing.

• 

  Figure 4 Ultrawide fundus photograph (UWFP) and optical coherence tomography (OCT) of the left eye. UWFP shows decreased subretinal hemorrahge (SRH) at 1 month after intravitreal bevacizumab injection (A) and decreased subretinal fluid (SRF) with prominent subretinal elevated lesion is seen on OCT (B). 1 month after intravitreal aflibercept injection (1st), much decreased SRH (C) and decreased size of subretinal lesion with minimal SRF (D). 1 month after intravitreal aflibercept injection (2nd), SRH is nearly absorbed (E) and height of subretinal lesion is more decreased on OCT (F). After 1 year from the first visit, chorioretinal scarring (G) and remnant but stable subretinal lesion is noticed (H).

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