Choroidal Osteoma: Case Series

Purpose: To describe the clinical presentation, multimodal imaging findings, and management of patients with choroidal osteoma observed at a tertiary ophthalmic center. Methods: A retrospective case series of three patients (four affected eyes) diagnosed with choroidal osteoma at the Kazakh Eye Research Institute, Almaty, Kazakhstan. All patients underwent a comprehensive ophthalmic examination, including best-corrected visual acuity assessment, fundus photography, B-scan ultrasonography, optical coherence tomography (OCT), fluorescein angiography (FA), OCT angiography, and computed tomography (CT). Results: The patients presented with decreased vision, progressive visual impairment, or vitreous floaters. Choroidal osteoma was identified as a yellowish-white or orange peripapillary subretinal lesion with well-defined borders. Multimodal imaging demonstrated characteristic calcified choroidal lesions with high acoustic reflectivity on ultrasonography, hyperdense plaques on CT, and hyperreflective heterogeneous structures on OCT corresponding to cancellous bone architecture. None of the patients demonstrated active choroidal neovascularization at presentation. Associated systemic or inflammatory conditions included systemic lupus erythematosus, retinal vasculitis, and chronic infectious exposure. All patients were managed conservatively with regular follow-up because of the absence of severe complications requiring intervention. Conclusions: Choroidal osteoma is a rare benign ossifying tumor that predominantly affects young individuals and may be associated with inflammatory or immune-mediated conditions. Multimodal imaging is essential for accurate diagnosis and monitoring. Although tumor progression is usually slow, long-term surveillance is necessary because of the risk of decalcification, retinal pigment epithelium atrophy, serous retinal detachment, and choroidal neovascularization.