Supplementary Material for: Novel Clinical Observations after Photodynamic Therapy in Choroidal Osteoma: A Three-Case Series

Introduction: Choroidal osteoma is a benign intraocular tumor that often presents in the juxtapapillary or macular region of young adult females. Factors contributing to severe vision impairment include tumor growth to the fovea, isolated subretinal fluid (SRF), alterations of the retinal pigment epithelium (RPE), macular edema, or serosanguineous SRF related to the development of choroidal neovascularization (CNV). This paper evaluates the effectiveness of photodynamic therapy (PDT) in treating symptomatic SRF and preventing foveal involvement, providing valuable long-term data and highlighting some previously unreported minor complications related to the treatment. Case Presentations: In case 1, a 2-year old woman with a juxtapapillary choroidal osteoma and symptomatic SRF was treated with PDT. Two months later, the visual acuity improved from 20/50 to 20/20 with complete resolution of the fluid. In case 2, an asymptomatic 22-year-old woman with a juxtapapillary choroidal osteoma was treated with a single PDT session, and progressive tumor decalcification was observed. Visual field testing after the treatment revealed the development of two small deep scotomas inferior to the physiological blind spot, which were not perceived by the patient, while visual acuity has remained at 20/20 fifteen years after the treatment. In case 3, a 38 year-old woman with a paracentral scotoma related to a juxtafoveal choroidal osteoma was treated with a single PDT session to prevent potential complications. Twenty days after the treatment, a subretinal hemorrhage was observed between the posterior margin of the tumor and the fovea, and two months later it spontaneously disappeared. Tumor decalcification was noticed four months after the treatment, the visual acuity dropped to 20/30, and the paracentral scotoma increased. Since then, the functional parameters have remained stable. Conclusion: This study reinforces the established role of PDT in the management of choroidal osteoma, resolving SRF, promoting tumor decalcification and preventing central tumor extension after long-term follow-up. However, it also highlights the occurrence of a self-limited sub retinal hemorrhage following the application of PDT and the development of permanent paracentral scotomas as a treatment-related effect.