Coexistence of choroidal osteoma, focal choroidal excavation, and choroidal neovascularization

Figure 1: (a) Fundus photograph showing yellowish orange flat lesion, with subretinal hemorrhage. (b) Optical coherence tomography (OCT) depicting horizontal hyper-reflective lamellae in the choroid (yellow box) suggestive of choroidal osteoma. (c) OCT-angiography showing neovascular network in the outer retinal slab (blue box). (d) OCT showing subretinal hyper-reflective material (blue arrowhead) corresponding to choroidal neovascularization (CNV) and focal choroidal excavation (yellow arrow heads)A 31-year-old lady presented with metamorphopsia in her left eye since 3 days. Fundus examination showed an orange flat lesion in the macula with subretinal hemorrhage suggestive of early-stage choroidal osteoma with active choroidal neovascularization (CNV), which was confirmed on ultrasonography, optical coherence tomography (OCT), and OCT-angiography. OCT also demonstrated the presence of focal choroidal excavation (FCE) [Fig. 1]. Co-occurrence of choroidal osteoma and FCE is known[1] and is postulated to be secondary to CNV scar and/or tumor decalcification.[2] The absence of scar/decalcification in this case suggests that FCE can occur even in the early stages of choroidal osteoma. 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 The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.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.