Título

COMBINED THERAPY FOR REFRACTORY NEOVASCULARIZATION IN CHOROIDAL OSTEOMA: TWO YEARS OF FOLLOW-UP

Introdução / Purpose

To report a case of unresponsive choroidal osteoma (CO) neovascularization successfully treated with combined therapy of laser photocoagulation and intravitreal aflibercept.

Material e Método / Methods

This is a case report of one patient.

Resultados / Results

A 62-year-old woman was referred for recurrent metamorphopsia and diminished vision in the right eye (OD) over eight months. She had been treated for a “leaky” CO with three monthly injections of 1.25mg bevacizumab, followed by three injections of 0.5mg ranibizumab. She did not undergo any treatment for the left eye (OS). The best corrected VA was 20/80 in OD and hand motion in OS. Fundus examination showed an ill defined lesion with signs of neovascularization in OD, and choriorretinal atrophy in OS. Right eye FA and OCT confirmed active neovascularization. The patient was treated with argon laser photocoagulation at membrane site combined with 2.0mg intravitreal aflibercept. At one month follow-up, VA was 20/50, metamorphopsia improved and OCT did not detect residual fluid. After two years, VA remained stable, the tumor did not enlarge and no residual activity was detected at the neovascular complex.

Discussão e Conclusões / Discussion

Choroidal osteoma presents as a benign calcified mass mainly in women between 20-40 years old. Secondary neovascularization is a common complication, ranging from 31-47%, and leads to poor outcomes. Multiple treatment modalities have been studied, mostly based on anti-VEGF drugs and photodynamic therapy (PDT), yet none has proven definitive in long term. As described, our patient evolved with sustained anatomical and functional improvement after combined therapy for two years. We hypothesize that this was due to a synergetic effect provided by laser-induced angio-occlusion and VEGF downregulation. Despite limitations regarding the underlying mechanism, this case report highlights the heterogeneous response of tumors like CO. It raises the need to further study on combined treatment regimens due to the lack of literature in this field.

Palavras Chave

Choroidal osteoma; choroidal neovascularization; neovascular membrane