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• W4313453884 abstract "A bony hard choroid A 48-year-old female patient came for a regular eye checkup. On examination, the best corrected visual acuity was 6/6, N6 in both eyes. Fundus examination of the left eye showed an oval-shaped, orange-red choroidal lesion in the peripapillary area with well-defined smooth margins; the fovea was spared. Peripapillary chorioretinal atrophy was noted nasal and inferior to the disk [Fig. 1a]. What is your next step? A) B-scan B) OCT C) Fundus autofluorescence D) All of the above. Findings Ultrasound B scan showed peripapillary high reflective plaque-like lesion at the level of choroid persisting in lower gain, suggesting calcification. Optical coherence tomography (OCT) showed lesion sparing the fovea, schitic separation of the inner nerve fibers at the optic disk, and cavitation at the level of choroid corresponding to the peripapillary atrophy. OCT through the lower part showed hyporeflective areas giving intrinsic sponge-like appearance in the deossified area and lamellar appearance and posterior shadowing at the ossified area [Fig. 1b].Figure 1: (a) Fundus shows orange red lesion in the peripapillary area sparing the fovea. Inset picture: B scan shows high reflective plaque echo at the level of choroid, suggestive of calcification. (b) OCT shows the lesion sparing the fovea (a), schitic separation of the inner nerve fibers at the optic disk, and cavitation at the level of choroid corresponding to the peripapillary atrophy (red star). OCT through the lower part shows hyporeflective areas giving sponge-like appearance in the deossified area (yellow star) and lamellar appearance and posterior shadowing in the ossified area (white star). OCT = optical coherence tomographyDiagnosis Choroidal osteoma of the left eye Correct answer: D. All of the above. Discussion Choroidal osteoma is rare benign ossifying tumor characterized by mature cancellous bone involving the choroid.[1] It presents with blurred vision (due to Choroidal neovascular membrane (CNVM) or retinal pigment epithelium atrophic changes), metamorphopsia, photophobia, and visual field defects. It is seen as a yellow white to orange elevation of choroidal mass with well-defined, irregular scalloped, or geographic borders in the juxtapapillary, peripapillary, and macular regions. It may be associated with depigmentation of overlying Retinal pigment epithelium (RPE) and with multiple small vascular networks on the tumor surface.[23] Differential diagnosis includes choroidal metastasis, sclerochoroidal calcification, amelanotic choroidal nevus, serpiginous choroiditis, choroidal hemangioma, choroidal granuloma (tuberculosis, sarcoidosis), and metastatic and dysmorphic calcification. 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." @default.
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• W4313453884 date "2023-01-01" @default.
• W4313453884 modified "2023-09-27" @default.
• W4313453884 title "A bony hard choroid" @default.
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• W4313453884 doi "https://doi.org/10.4103/ijo.ijo_1688_22" @default.
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