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