Choroidal Excavation in Case of Bilateral Choroidal Osteoma with Choroidal Neovascularization

Purpose: To report a rare case of bilateral choroidal osteoma and choroidal neovascularization (CNV) in the right eye associated with a focal choroidal excavation.Methods: A 32 years old healthy female presented with decreased visual acuity (VA) of her right eye, complete ophthalmic examination, Fluoresceinangiography(FAG) , Enhanced depth imaging optical coherence tomography (EDI-OCT) and indocyanin green angiography (ICG) were performed. Results: : VA were 20/100 and 20/20 in the right and left eye respectively.Bilateral ,multifocal yellow-orange lesion in the level of choroid whit sharp borderswas observed on funduscopy .FAG demonstrated bilateral macular hyperfluorescence lesions due to window defect of choroidal mass as well as juxtafoveal hyperfluorescence lesion in the right eye correspond to active CNV.(Figure 2). EDI-OCT showed choriocapillaries vessels thinning and large choroidal vessel and sponge like choroidal lesion compatible with choroidal osteoma and CNV in the righteye. Following multiple intravitreal injection of bevacizumab (IVB), subretinal fluid and retinal thickening was resolved and focal choroidal excavation in the site of CNV was appeared. Conclusion: CNV in choroidal osteoma can lead to focal choroidal excavation and choroidal excavation can lead to CNV development. This cascade can deteriorate vision and sometimes resulted in permanent visual loss.