J Korean Ophthalmol Soc JKOS Journal of the Korean Ophthalmological Society 0378-6471 2092-9374 The Korean Ophthalmological Society 10.3341/jkos.2018.59.10.989 Case Report A Case of Choroidal Osteoma with Subretinal Hemorrhage Improved by Intravitreal Bevacizumab and Aflibercept Injections Kim Charm MD Choi Kyung Seek MD Sun Hae Jung MD Department of Ophthalmology, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea. Address reprint requests to Hae Jung Sun, MD. Department of Ophthalmology, Soonchunhyang University Seoul Hospital, #59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea. Tel: 82-2-709-9354, Fax: 82-2-710-3196, sunhj99@schmc.ac.kr 10 2018 17 10 2018 59 10 989 994 07 06 2018 24 07 2018 27 09 2018 ©2018 The Korean Ophthalmological Society 2018 The Korean Ophthalmological Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 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.

 Aflibercept Bevacizumab Choroidal osteoma Subretinal hemorrhage Soonchunhyang University https://doi.org/10.13039/501100002560

The study was presented as an e-poster at the 117th Annual Meeting of the Korean Ophthalmological Society 2017.

This study was supported by an Industry-academic cooperation of Soonchunhyang University 2018.

The authors have no conflicts to disclose.

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