Development of Choroidal Neovascularization after Treatment with Photodynamic Therapy in a 5-year old Female with Choroidal Osteoma.

PURPOSE To describe a patient with a choroidal osteoma treated with PDT to prevent tumor growth in whom choroidal neovascularization (CNV) developed after being treated with PDT. METHODS Case report. RESULTS A 5-year-old Hispanic female presented with an asymptomatic choroidal osteoma, temporal to the macula of her right eye. According to the patient's mother, her medical, surgical and family history was unremarkable. At examination, best corrected visual acuity was 20/30 in both eyes. After 11 months of follow-up, signs of tumor growth toward the fovea without any signs of CNV was noted. PDT was performed in order to prevent invasion of the foveola. Two months thereafter, the patient developed CNV in the macula region in the right eye, decreasing visual acuity to 20/200. The patient was treated with four total intravitreal injections of 1.25 mg of bevacizumab over 24 weeks, which resulted in inactivation of the CNV and improved visual acuity to 20/20. CNV had been never reported in her past history as well as her follow up visits over seven years. In addition, no evidence of recurrent neovascular activity or tumor growth was reported. CONCLUSIONS Choroidal osteoma is a benign tumor that can result in vision-threatening complications, caused by tumor growth and tumor decalcification. PDT is an effective modality in inducing choroidal osteoma decalcification and stabilization; however, CNV due to reperfusion following PDT can be seen in the retina.