Supplementary Material for: Secondary choroidal osteoma in the setting of uveal pathology: 4 case reports and review

Purpose: Choroidal osteoma is a rare benign tumor where mature bone replaces the choroid. Possible causes include inflammation, trauma, hormones, disorders of calcium metabolism, environmental factors, genetics, or osseous choristoma. This paper discusses cases and literature regarding choroidal osteoma occurring concurrently with or secondary to uveal pathologies including uveitis and pachychoroid spectrum. Methods: Report of four cases and review of the literature. Case 1: A 41-year-old man with central serous chorioretinopathy (CSCR) in both eyes (OU) developed a choroidal osteoma in the left eye (OS) eight years after the initial visit. Type 1 macular neovascularization (MNV) developed four years later at age 53. Case 2: A 50-year-old woman with CSCR OU developed a choroidal osteoma OS 15 years after the initial visit. The lesion gradually enlarged over another 15 years of observation. Case 3: A 24-year-old woman with Vogt-Koyanagi-Harada disease treated with systemic corticosteroids for six months developed choroidal osteoma OU and type 2 MNV in the right eye (OD) 16 years after the initial visit. Case 4: A 55-year-old man with concurrent posterior scleritis and choroidal osteoma OS developed type 1 MNV 13 years after the initial visit. He had a history of unknown uveitis treated with high-dose corticosteroid therapy 21 years previously. In all five eyes, the presence of osseous tissue in the choriocapillaris and Sattler's layer was confirmed by optical coherence tomography (OCT), B-mode ultrasound, or computed tomography. These lesions demonstrated observed growth in basal diameter and/or maturation process of bone tissue throughout the follow-up period. Conclusion: We observed five eyes of four patients with choroidal osteoma in the choriocapillaris and Sattler’s layer of the choroid secondary to CSCR, Vogt-Koyanagi-Harada disease, or posterior scleritis over a long follow-up period of 12 to 30 years. Secondary choroidal osteoma, ectopic bone in the choroid, can result from the transformation of mesenchymal cells stimulated by osteoprogenitors, such as bone morphogenetic proteins. Secondary choroidal osteoma should be recognized as a rare long-term complication of uveal pathologies.

【研究背景】脉络膜骨瘤（Choroidal osteoma）是一种罕见良性肿瘤，以成熟骨组织替代脉络膜为主要病理特征。其潜在致病因素涵盖炎症、外伤、激素异常、钙代谢紊乱、环境因素、遗传因素，或骨性迷芽瘤（osseous choristoma）。本研究探讨了合并或继发于葡萄膜病变（包括葡萄膜炎及肥厚性脉络膜谱（pachychoroid spectrum））的脉络膜骨瘤的病例及相关文献。【研究方法】本研究纳入4例病例并进行文献回顾。病例1：41岁男性，双眼（OU）罹患中心性浆液性脉络膜视网膜病变（central serous chorioretinopathy, CSCR），初诊8年后于左眼（OS）发生脉络膜骨瘤；53岁时（即确诊脉络膜骨瘤4年后）出现1型黄斑新生血管（type 1 macular neovascularization, MNV）。病例2：50岁女性，双眼CSCR，初诊15年后于左眼出现脉络膜骨瘤，后续15年随访期间病灶逐渐增大。病例3：24岁女性，因伏格特-小柳-原田病（Vogt-Koyanagi-Harada disease）接受为期6个月的全身糖皮质激素治疗，初诊16年后出现双眼脉络膜骨瘤，右眼（OD）并发2型黄斑新生血管。病例4：55岁男性，左眼同时合并后部巩膜炎（posterior scleritis）与脉络膜骨瘤，初诊13年后出现1型黄斑新生血管；患者21年前曾因不明原因葡萄膜炎接受大剂量糖皮质激素治疗。所有5只患眼的脉络膜毛细血管层及萨特勒层（Sattler's layer）均经光学相干断层扫描（optical coherence tomography, OCT）、B型超声或计算机断层扫描证实存在骨组织；随访期间所有病灶均出现基底直径增大及/或骨组织成熟过程的进展。【研究结论】本研究对4例患者的5只患眼进行了长达12~30年的随访，发现其脉络膜毛细血管层及萨特勒层的脉络膜骨瘤均继发于CSCR、伏格特-小柳-原田病或后部巩膜炎。继发性脉络膜骨瘤即脉络膜异位骨组织，可由骨形态发生蛋白等骨祖细胞刺激间质细胞转化所致。继发性脉络膜骨瘤应被视为葡萄膜病变的一种罕见远期并发症。