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Photodynamic Therapy with Verteporfin in Choroidal Osteoma with a Choroidal Neovascular Membrane

Kraft J., Klink T., Lieb W.,
Bayerische Julius-Maximilians-Universität Würzburg, Universitäts-Augenklinik (Würzburg)

Introduction: A serious complication of choroidal osteoma is the formation of choroidal neovascularization (CNV) that may lead to a severe loss of vision. To our knowledge there is up to date no publication on Photodynamic therapy (PDT) with Verteporfin in this disease.
Method: A 32-year-old woman with a known choroidal osteoma extending the posterior pole on the left eye was evaluated for a 4 weeks history of blurred vision and metamorphosis in the left eye. Best-corrected visual acuity was 20/80. Funduscopic examination showed subretinal exudation and changes in retinal pigment epithelium in the centre of the osteoma. Fluorescein angiography revealed a subfoveal well defined neovascularization in the early phase and leakage of dye in the late phase. After the first Photodynamic therapy a regression of the membrane activity and signs of scarring were found in combination with marked choriocapillaris atrophy. 6 months later a recurrent membrane in the nasal part occurred and a second PDT was initiated. Visual acuity improved to 20/50 and metamorphopsia resolved.
Conclusions: Argon- and Krypton-photocoagulation has been reported in the treatment of extrafoveolar CNV in choroidal osteoma with limited success. PDT offers new possibilities in the treatment of subfoveolar membranes in choroidal osteomas. Because of the osteoma-associated atrophy of the retinal pigment epithelium a stronger effect on the choriocapillaris has to be expected as demonstrated in our patient.