A 28-year-old female patient presented with metamorphopsia in her left eye starting 2 days earlier. There was nothing of note in her medical or family history, and her visual acuity was 1.0 in the right eye and 0.8 with -5.0 D refraction in the left eye. Anterior segment examination was normal. Fundus examination was normal in the right eye, but macular pigmentary alterations were observed in the left eye (). On FFA there was hyperfluorescence beginning in the early phases and increasing in the late phase, which was more suggestive of choroidal neovascular membrane (CNVM) than CSCR (). Although it is recommended for a definitive diagnosis, ICGA was not done. Despite smooth foveal contours in the left eye on OCT, an area of subfoveal focal choroidal excavation and overlying hyporeflective subretinal fluid were detected (). The lesion in the patient’s left eye was accepted as CNVM and an intravitreal bevacizumab injection was administered. At follow-up 1 month later, the patient’s symptoms had improved, vision in her left eye improved to 0.9 and the hyporeflective area evident on OCT had decreased in size. At 2-year follow-up, visual acuity in the left eye was 0.8 and persistent RPE changes were observed on fundoscopy (). Hyperfluorescence which increased slightly in the late phases was observed on FFA of the left eye (). On OCT, the focal choroidal excavation remained unchanged, the overlying hyporeflective area had resolved and the photoreceptor layer appeared continuous ().
A 46-year-old male patient presented to us with blurring of vision OS since 2 months. His BCVA was 6/6, N6 in OD and 6/12, N8 in OS at presentation. Fundus examination of OS showed an irregular elevated, yellowish-white choroidal lesion with welldefined geographic borders involving the inferior macula with areas of subretinal hemorrhage at and above the fovea suggestive associated choroidal neovascular membrane. SD-OCT showed a dense hyper-reflective choroidal mass with significant widening of the choroidal layers. B-scan ultrasonography revealed high-spike echoes through the lesion suggesting choroidal osteoma. FFA in that area showed staining conforming to the diagnosis of choroidal osteoma with a secondary CNVM. Patient underwent treatment with multiple antiVEGF injections and standard fluence photodynamic therapy (PDT). The patient developed an acquired FCE after 17 months of treatment [].