Abstract
PURPOSE: To report a case of bilateral choroidal osteoma successfully treated with subscleral sclerectomy for secondary serous retinal detachment (SRD). OBSERVATIONS: A 52-year-old Japanese woman first diagnosed with Vogt-Koyanagi-Harada disease and treated with steroids for 9 years was referred to our clinic. SRD in both eyes recurred frequently and was uncontrolled with adalimumab subcutaneous injections and oral cyclosporine, in addition to steroids. A yellowish-to-orange, slightly elevated subretinal lesion was observed superior to the macular and inferotemporal regions of the right eye and superior to the macular and temporal regions of the left eye without any inflammation. Swept-source optical coherence tomography (OCT) revealed SRD in the fovea and a mass under the retinal pigment epithelium (RPE) in the macular area of both eyes. Indocyanine green angiography (ICGA) demonstrated hypocyanescence corresponding to the mass area under the RPE, with dilation of the dominant vortex veins. Ultrasonography revealed a hyperechogenic mass in the posterior wall of both eyes with deeper acoustic shadows, and computed tomography (CT) detected calcifications in the posterior wall of both eyes. A bilateral choroidal osteoma was diagnosed, and the superior SRD of her left eye increased toward the fovea without any evidence of choroidal neovascularization during follow-up. Therefore, subscleral sclerectomy (4 × 4 mm(2) sclerectomy under the scleral flap) was performed at three sites at the equators in the upper temporal, upper nasal, and lower temporal quadrants of her left eye. Immediately after surgery, SRD resolved dramatically. As the foveal SRD of her right eye also increased after two months, the same surgery was performed, and it worked successfully. CONCLUSIONS AND IMPORTANCE: Choroidal osteoma can cause severe SRD that cannot be controlled with medication. Although further studies are needed, subscleral sclerectomy may be an effective treatment for the resolution of subretinal fluid secondary to choroidal osteoma by improving choroidal circulation congestion.