A rare presentation of asymptomatic multifocal choroidal osteoma

Choroidal osteoma (CO) is a rare, unilateral, solitary, benign ossifying choroidal tumor usually seen in young, myopic females with unknown incidence.[1-3] Here we describe its rare, multifocal presentation.[2-4] Case Details A 21-year-old female presented for a routine eye checkup with BCVA and IOP of 20/20, N6 and 16 mmHg, respectively, in both eyes. The fundus in the right eye (OD) was unremarkable [Fig. 1a], whereas the left eye (OS) revealed a subretinal yellowish white lesion, 2 DD in size with orangish diffused scalloped margins inferior to the optic disc and an orangish lesion with diffuse margin, 1/2 DD in size inferotemporal to the macula [Fig. 1b]. FAF of the OD was unremarkable [Fig. 1c], whereas in OS, the lesion near the disc revealed hypofluorescence surrounded by areas of granular hyperfluorescence, and the lesion temporal to the macula showed subtle hyperfluorescence [Fig. 1d]. OCT of the lesion near the disc revealed localized elevated retinal contour, thinning of the external retina along with disruption of the outer retinal layers with compression of the vascular layer of the choroid, and well-circumscribed heterogeneous mass with hyperreflective dots [Fig. 2a], whereas OCT of the lesion temporal to the macula revealed compression of the vascular layer of the choroid and a heterogenous mass with hyperreflective dots [Fig. 2b]. OS B-scan showed an echo-dense lesion adjacent to the optic disc with back-shadowing (pseudo optic disc appearance) [Fig. 2c].Figure 1: Fundus photo (a and b) and autofluorescence (c and d) of the right and left eye, respectively. Figure 1b insets: OCT through the lesions, and the yellow and red asterisks highlight the CO lesion near the disc and macula, respectivelyFigure 2: OCT of the lesion near the disc indicated by red asterisks (a) and temporal to the macula showing the compression of the vascular layer indicated by yellow asterisks (b). B scan showing an echo dense lesion adjacent to the optic disc with back shadowing suggestive of pseudo optic disc appearance (yellow asterisks)(c)Discussion The first case was reported by Gass et al. in 1978.[1] Xuan Yi et al.[2] reported multifocal tumors in two out of 23 eyes. Deuri et al.[4] reported multiple COs in a 9-year-old boy. Kolkedi et al.[5] have also reported bilateral multifocal CO associated with optic disc edema. Although no specific treatment is available, PDT can be considered for extrafoveal CO and anti-VEGF injection for CNV associated with CO.[6] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.