Research progress on the decalcification mechanism of choroidal osteoma and neovascular complications_Chinese Journal of Ocular Fundus Diseases

Authors：

Zhang Qiming ¹ , Xu Aizhen ¹ , Chang Hongmin ² ,  Li Chuanbao ²

1. School of Clinical Medicine, Jining Medical University, Jining 272000, China;
2. Department of Ophthalmology, Affiliated Hospital of Jining Medical University, Jining 272029, China;

Corresponding author：

Li Chuanbao, Email: 13853708298@126.com

Keywords：

Choroidal osteoma; Benign intraocular tumor; Choroidal tumor; Choroidal neovascularization; Review

DOI：

10.3760/cma.j.cn511434-20250725-00323

Video：

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Choroidal osteoma (CO) is a rare benign intraocular tumor that predominantly affects young women, characterized by the presence of mature trabecular bone within the choroid. As the disease progresses, decalcification frequently occurs, leading to mineral loss and disruption of the trabecular structure, which subsequently causes disorganization of the outer retinal layers and damage to the photoreceptors, ultimately resulting in visual loss. Decalcification is closely associated with the development of choroidal neovascularization (CNV), a major factor contributing to poor visual prognosis. The mechanisms underlying this association may involve the disruption of the retinal pigment epithelium and Bruch's membrane caused by decalcification, as well as the increased secretion of inflammatory factors such as vascular endothelial growth factor (VEGF). The origin of CO remains unclear but is likely related to congenital conditions, inflammation, endocrine imbalances, and other factors. The occurrence of decalcification is closely linked to prolonged disease duration, changes in estrogen levels, chronic ocular inflammation, genetic susceptibility, and other factors. Clinically, CO is diagnosed primarily through fundus examination combined with multimodal imaging. CT can confirm the diagnosis by detecting osseous calcifications. Fluorescein angiography, fundus autofluorescence, indocyanine green angiography, and optical coherence tomography, optical coherence tomography angiography are valuable for diagnosis, monitoring decalcification, and assessing complications. CO can be easily confused with other intraocular tumors such as choroidal melanoma and metastatic choroidal carcinoma, as well as with calcified conditions, necessitating careful differential diagnosis. There is currently no standardized treatment for CO. For tumors without decalcification, regular follow-up is the main approach. For those with decalcification or complications such as CNV, treatments mainly include intravitreal anti-VEGF injections, photodynamic therapy (PDT), and laser photocoagulation. Anti-VEGF therapy is the most commonly used method, effectively controlling CNV and stabilizing or even improving vision. However, it is important to note that PDT and laser treatments may induce or exacerbate decalcification.Future management strategies should be tailored based on the tumor's location, the presence of decalcification, and the presence of complications. With the development of genomics and precision medicine, genetic screening and gene therapy hold promise for new directions in the prevention and treatment of CO.

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Chinese Journal of Ocular Fundus Diseases

Latest ArticlesResearch progress on the decalcification mechanism of choroidal osteoma and neovascular complications

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