Choroidal or subretinal neovascularization is an acquired abnormality
observed in many congenital, degenerative, infectious, inflammatory, tumoral,
and traumatic processes, some of which are more commonly observed in young
patients.8 Among these conditions, choroidal
osteomas may show a pattern similar to that seen in our patients. Choroidal
osteomas, in summary, are unique, unilateral tumors that arise in the juxtapapillary
and macular region of young adults.9 They
typically have an orange hue but may show some mottling of gray pigment on
the surface. The osteoblastic activity of osteomas may encapsulate some osteoclastic
change. Feeder vessels may be observed exiting from the holes in the anterior
surface of the cancellous bone. This process can evolve to true choroidal
neovascular membranes, which may reveal the osteoma.9
Case 4 also developed CNV with a typical feeder vessel. However, marked attenuation
of sound by the tumor ultrasonographically, which is typical of choroidal
osteomas, could not be demonstrated in our study in the 3 patients so tested.
In our cases, RPE changes may have facilitated the occurrence of CNV.