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Indian J Ophthalmol. 2019 Feb;67(2):300-302. doi: 10.4103/ijo.IJO_1076_18.

In vivo diagnosis of intraocular osseous metaplasia in neovascular age-related macular degeneration.

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Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom.
Department of Ophthalmology, Altnagelvin Area Hospital, Londonderry, United Kingdom.


A 75-year-old man presented with deterioration of right eye vision for 6 months. He had no relevant medical history. Fundus examination revealed subretinal fluid, fibrosis, and subretinal hemorrhages. Ocular coherence tomography of the right macula illustrated an underlying subretinal lesion with internal lamellae, resembling trabecular bone elsewhere in the body. Bruch's membrane was clearly intact beneath the lesion, indicating an extrachoroidal location. The lesion appeared highly reflective on B-scan ultrasonography, consistent with ossification. Although initially misdiagnosed as choroidal osteoma, this lesion represents in-vivo intraocular osseous metaplasia at the site of neovascular age-related macular degeneration. The authors believe that similar lesions may have been misdiagnosed as "atypical" osteoma caused by failure to identify their extrachoroidal location.


Age-related macular degeneration; Bruch's membrane; choroidal osteoma; intraocular ossification; metaplastic ossification; ocular coherence tomography; osseous metaplasia

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