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

Charm Kim; Kyung Seek Choi; Hae Jung Sun

doi:10.3341/jkos.2018.59.10.989

Journal List > J Korean Ophthalmol Soc > v.59(10) > 1103104

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Kim, Choi, and Sun: A Case of Choroidal Osteoma with Subretinal Hemorrhage Improved by Intravitreal Bevacizumab and Aflibercept Injections

Case Report

Journal of the Korean Ophthalmological Society 2018; 59(10): 989-994.

Published online: 17 October 2018

DOI: https://doi.org/10.3341/jkos.2018.59.10.989

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

Charm Kim, MD, Kyung Seek Choi, MD, Hae Jung Sun, 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

Received 7 June 2018 Revised 24 July 2018 Accepted 27 September 2018

The Korean Ophthalmological Society

(open-access):

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.

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.

Keywords: Aflibercept, Bevacizumab, Choroidal osteoma, Subretinal hemorrhage

Figures and Tables

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).

Notes

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.

^{Conflicts of Interest} The authors have no conflicts to disclose.

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