Predictive Factors and Tumor Dynamics in Choroidal Osteoma: A Multimodal Imaging-Based Longitudinal Analysis.

PURPOSE: To evaluate longitudinal multimodal imaging changes in choroidal osteoma (CO) and analyze factors predisposing to sequelae.

DESIGN

Retrospective, observational study.

PARTICIPANTS

Patients with a diagnosis of CO.

METHODS

Baseline clinical characteristics and agewise distribution of various multimodal imaging parameters, such as total osteoma area, area of retinal pigment epithelium (RPE) atrophy, and area of decalcified choroidal atrophy (d-CA), were analyzed. Eyes with well-documented longitudinal follow-up were also analyzed.

MAIN OUTCOME MEASURES: Multimodal imaging features of CO in the calcified and decalcified areas and identification of changes in the CO lesion parameters and factors predisposing to CO sequelae.

RESULTS

The study included 92 eyes of 73 patients (37 men and 36 women) with a mean age of 32 ± 13.6 years. At baseline, uncomplicated CO was noted in 17.4% of eyes, whereas d-CA was seen in 39.1% of eyes, and RPE atrophy without underlying d-CA was noted in 35.9% of eyes. Choroidal neovascular membrane (CNVM) was seen in 47.8% of eyes. Subretinal fluid (SRF) without CNVM was present in 14 eyes (15.2%). Thirty-five eyes were included for longitudinal analysis. On regression analysis, factors associated with the presence of CNVM at baseline were the presence of d-CA (P = 0.04), RPE atrophy (P = 0.04), and macular involvement (P = 0.001). A higher rate of increase in the d-CA area was associated with a higher total baseline area of the osteoma (P = 0.02). The presence of CNVM (P = 0.04) and retinal pigment epithelium atrophy (P = 0.03) was associated with a faster rate of reduction of osteoma thickness. A faster increase in osteoma thickness was associated with SRF appearance (P = 0.04). Three zones could be identified clinically in eyes with d-CA (i.e., a calcified area with no RPE atrophy, a transition zone of calcified area with overlying RPE atrophy, and a d-CA area).

CONCLUSIONS

Retinal pigment epithelium atrophy and d-CA are clinically important and quantifiable prognostic factors in the natural history of CO lesions. Three different CO subtypes and zones could be identified that had unique clinical significance.

FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.