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The aim of this article is to report the presence of choroidal loculation of fluid and choroidal cavern in a case of choroidal osteoma, previously undescribed in this disease.
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PURPOSE: To describe characteristics of choroidal osteomas (CO), using ocular ultrasound, fluorescein angiography, ultra-widefield retinal imaging, ultra-widefield autofluorescence, optical coherence tomography, enhanced-depth-imaging OCT, and OCT angiography (OCT-A). METHODS: Retrospective, observational case series study. Clinical records from patients with diagnosis of CO who underwent complete imaging evaluation were analyzed. RESULTS: Sixteen eyes from 11 patients were included. Mean patient age was 33.4 years (range 20-61), 72.7% were female, 100% were Hispanic, and 54.5% had unilateral CO. Median visual acuity was 20/150 (range 20/20-2000). CO was completely calcified in 25%, partially decalcified in 50%, and decalcified in 25%. Other features included choroidal neovascularization (18.75%), focal choroidal excavation (12.5%), choroidal depression associated to decalcification (18.75%), thinning of outer retina and photoreceptor layers over decalcified tumor (75%). Decreased fluorescence on FAF was observed in decalcified regions while relatively preserved fluorescence was observed in calcified regions. CONCLUSIONS: Nowadays, diagnostic tests provide important information about each stage of choroidal osteoma. Progressive decalcification of the tumor might have a common pathogenic role for development of FCE or choroidal depression. OCT-A/FA proved to be valuable tools for detection of CNV in patients with CO.
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Introducción: el osteoma coroideo (OC) es un tumor benigno de la coroides, muy poco frecuente, capaz de producir auténtico tejido óseo. Afecta típicamente a mujeres jóvenes y sanas y se localiza en el polo posterior, preferentemente en la región yuxtapapilar. Generalmente es una lesión unilateral con etiología aún desconocida. Mediante la ultrasonografía y la tomografía computarizada se puede llegar al diagnóstico al demostrar la placa calcificada correspondiente a la lesión. Caso clínico: presentamos el caso de osteoma coroideo en una paciente femenina de 36 años de edad con pérdida de la agudeza visual de ojo izquierdo y antecedente de trauma ocular. En la TAC de orbita hubo una calcificación alargada de aproximadamente 7mm localizada en la región posterior superior del ojo izquierdo, aparenta yuxtapapilar, que no se modifica con el contraste en relación con osteoma coroideo. Se realizó tomografía de coherencia óptica de OI donde se evidenció elevación del EPR, posible lesión sugerente de una membrana neovascular coroidea y líquido subretinal, por lo cual se colocó 3 dosis de antiangiogénicos, mejorando la visión a cuenta dedos a 2 MT. Conclusiones: el osteoma coroideo es un tumor intraocular benigno poco frecuente, más común en pacientes jóvenes sanas cuyo diagnóstico se confirma con la calcificación visible por TAC; entre las complicaciones que producen baja visón está el desprendimiento exudativo y hemorragia, en donde está indicado terapia fotodinámica, fotocoagulación y antiangiogénicos.
Introduction: choroidal osteoma (OC) is a rare benign tumor of the choroid, capable of producing real bone tissue. It typically affects young healthy women, and it is located in the posterior pole, preferably in the juxtapapillary region. It is usually a unilateral lesion with still unknown etiology. Diagnosis can be made by ultrasonography and computed tomography by showing the corresponding calcifed plaque of the injury. Case study: we report a case of choroidal osteoma in a female patient of 36 years of age with loss of visual acuity of the left eye and a history of ocular trauma. In the TAC there was an elongated orbit calcifcation of about 7mm, located in the upper posterior region of the left eye, appears juxtapapillary, which is not modifed by the contrast in relation to choroidal osteoma. Optical coherence tomography was performed in the LE, where EPR evidenced elevation, a possible lesion suggestive of choroidal neovascular membrane and subretinal fuid, applying 3 doses of antiangiogenic, improving vision. Conclusions: choroidal osteoma is a rare benign intraocular tumor, more common in young healthy patients whose diagnosis was confrmed by CT visible calcifcation; among its complications that cause low vision is the exudative detachment and bleeding; being photodynamic therapy, photocoagulation and antiangiogenic treatment of choice.
Assuntos
Humanos , Feminino , Adulto , Osteoma , Mulheres , Osso e Ossos , Tomografia Computadorizada por Raios X , Corioide , Ultrassonografia , Neoplasias da Coroide , Estrabismo , Inibidores da AngiogêneseRESUMO
El osteoma coroideo es un tumor benigno, óseo y fue descrito por primera vez en 1978 por Gass y otros. Generalmente es unilateral, de localización juxtapapilar y más frecuente en mujeres adultas jóvenes. Presenta una etiología desconocida pero se asocian diferentes factores como: procesos inflamatorios, malformaciones congénitas, alteraciones hormonales y traumas oculares entre otros. Se presenta una paciente del sexo femenino, de 54 años de edad, con antecedentes patológicos personales de fibromialgia reumática (osteoartritis y osteoporosis) e hipertensión arterial. En los antecedentes oftalmológicos presentaba miopía leve y retinopatía arteriolosclerótica. La paciente refiere que sufrió un accidente de tránsito y recibió lesiones contusas en miembros y región periocular. A partir de ese momento comenzó con mala visión del ojo derecho y acude a nuestro servicio seis meses después. Se le realizó examen oftalmológico y los datos positivos en el ojo derecho fueron una agudeza visual de 0,4, con corrección alcanzaba 1,0 y al fondo de ojo se detecta estreches vascular, desprendimiento de vítreo posterior incompleto y una lesión blanquecina naranja de tres diámetros papilares en polo posterior que involucraba arcada temporal inferior con borde bien definidos. Se realizó angiografía que mostró hiperfluorescencia mantenida y no neovascularización; la tomografía de coherencia óptica reveló un halo de desprendimiento de retina seroso a su alrededor. El ultrasonido destaca una imagen ecogénica de alta reflexividad que involucra coroides con silencio acústico posterior. El osteoma constituye una patología no muy frecuente, cuyo diagnóstico es imagenológico, y se destaca el hecho de ser secundario a un trauma ocular.
The choroidal osteoma is a benign bony tumor described for the first time in 1978 by Gass and collaborators. It is generally unilateral, with juxtapapillary localization and more frequent in young adult females. It presents unknown etiology, but it is associated to different factors as inflammatory processes, congenital malformations, hormonal alterations and ocular traumas among others. The patient was a 54 year-old woman with a personal history of rheumatic fibromyalgia (osteoarthrosis and osteoporosis) and hypertension. Her ophthalmological antecedent showed myopia and arteriolosclerotic retinopathy. At the beginning of the year, she suffered a traffic accident and was injured in her limbs and periocular region. After this, she began feeling blurred vision of the right eye and she went to our service 6 months later. She was performed an ophthalmologic exam. It was found that the right eye had visual acuity of 0.4, and after correction it reached 1.0 .Funduscopy revealed vascular thinness, incomplete posterior vitreous detachment, and a white-orange lesion of 3 papillary diameters that involved inferior temporary arcade with well-defined borders. An angiography was performed, which showed sustained hyperfluorescence and non neovascularization; and the optic coherence tomography revealed a halo of serous retinal detachment. Additionally, the ocular ultrasound yielded a high reflectivity echogenic image that involves choroids with posterior acoustic shadow. It is for this reason that we affirm the traumatic etiology of the lesion. This is a rare pathology that should be diagnosed by imaging techniques. Notably, it is secondary to an ocular trauma.