Intravitreal Anti-Vascular Endothelial Growth Factor Treatment for Choroidal Neovascularization in Choroidal Osteoma: A Pilot Study

Abstract

Purpose: To determine the long-term visual and anatomical outcomes, recurrence risk, and prognostic factors after intravitreal anti-vascular endothelial growth factor (VEGF) treatment for choroidal neovascularization (CNV) in eyes with choroidal osteoma. Methods: A retrospective review included patients diagnosed with choroidal osteoma and secondary CNV who received at least one intravitreal anti-VEGF injection at a single tertiary center between 2005 and 2023. Variables collected included demographics, baseline and final visual acuity, CNV location and type, imaging results, recurrence events, and adjunctive therapies. The main outcomes were change in visual acuity, proportion of eyes with final vision ≤20/200, and recurrence rate. Multivariable Firth-penalized logistic regression identified factors associated with poor prognosis. Results: Of 17 eyes (mean age 32.0 years, 58.8% female), 15 (88.2%) achieved anatomical control, but only four (23.5%) achieved visual acuity improvement of two or more lines. Recurrences were observed in 12 eyes (70.6%), with most occurring within the first year after treatment. Lower initial visual acuity was associated with a worse prognosis (aOR 4.49, 95% CI 0.99–596.72), and non-subfoveal CNV location (aOR 0.27, 95% CI 0.02–2.29) and type 2 CNV (aOR 0.23, 95% CI 0.01–2.20) tended to be associated with a better visual outcome. Conclusions: Anti-VEGF treatment was effective in achieving anatomical stabilization in CNV associated with choroidal osteoma, but visual recovery was limited. Given the high risk of recurrence, particularly within the first year after treatment, individualized strategies and early and long-term follow-up are essential.