Role of Intravitreal Anti-VEGF Injections in Choroidal Osteomas- A Collaborative Study

Abstract

Purpose: : A choroidal osteoma is a rare benign choroidal tumor involving the peripapillary and macular areas of young healthy subjects with very slow growth and often with an acute decrease in vision. The main causes of this sudden decrease in vision are a serous macular detachment or a subretinal hemorrhage, with or without choroidal neovascularization (CNV). A definitive treatment for the CNV associated with a choroidal osteoma has not been established like photocoagulation, surgical removal of the CNV, photodynamic therapy (PDT) and transpupillary thermotherapy.

Methods: : Multicenter retrospective collaborative study of the use of anti-VEGF in the therapy of serous detachment with or without CNV. Intravitreal injections of vascular endothelial growth factor (VEGF) antibody (bevacizumab or ranibizumab) were administered as 3 initial consecutive doses or based on OCT response. PDT was administered simultaneously in some patients.

Results: : 20 pts had an age mean 29.2 years (range 8-48) with a majority of women (14 female and 6 male) and a majority of Caucasians (14 Caucasian, 4 Indian, 2 Asian). The right eye was involved in 9 and the left in 10 eyes (1 unspecified). The longest measure of the osteoma had a median of 4 disc diameter (mean 4.9 disc diameter; range 1-10). The osteoma was subfoveal in location in 15 cases and peripapillary in 5 cases. There was no correlation between osteoma size and initial vision (Pearson correlation=0.133; two-tailed probability p=0.54). Eight cases presented with subretinal hemorrhage and the rest with subretinal fluid. The CNV was subfoveal in 12, juxtafoveal in 1, extrafoveal 3, peripapillary in 2, unspecified in 1, and absent in 1 case. Intravitreal bevacizumab was used in 12 cases, ranibizumab in 6 cases, and a combination in 2 cases. Mean number of injections was 4.9 (range 1-15; median 3) with a follow-up of 20.6 months (range 1-52). Five cases had additional PDT. Initial acuities in log MAR was 0.85 and final vision was 0.57 with 2.8 lines of vision (p=0.016 by paired t-test). Visual acuity in 18 cases improved from 0.85 to 0.5 at 6 month after therapy with 3.5 lines of improvement (p=0.01). Visual acuity improved in 13 cases, stabilized in 2 cases and worsened in 4 cases (1 unspecified). No ocular or systemic adverse effects were noted. In 7 patients who had OCT at 6 month after therapy, 6 had flattening of the fovea and 1 was unchanged.

Conclusions: : Although the long term visual prognosis without therapy is not good, our findings indicate that intravitreal bevacizumab or ranibizumab prevents a decrease of vision in the short and long-term in a majority eyes with a choroidal osteoma with CNV.

Keywords: choroid: neovascularization • vascular endothelial growth factor • choroid