Progression of Choroidal Osteoma: A Case Series with Multimodal Imaging Update.

PURPOSE: To describe the clinical progression of choroidal osteoma (CO) in seven eyes using multimodal imaging and to assess treatment outcomes. METHODS: An observational case series. RESULTS: Seven eyes were diagnosed with CO with lesions predominantly located in the macular region. Initial visual acuity ranged from 20/20 to 20/150, and most eyes exhibited choroidal neovascularization, including polypoidal choroidal vasculopathy in two cases. Antivascular endothelial growth factor (anti-VEGF) therapy was administered to 86% of the affected eyes, leading to visual acuity stabilization or improvement. One eye experienced choroidal neovascular recurrence. Final visual acuity ranged from 20/20 to counting fingers after a follow-up period of 2-10 years. Multimodal imaging approaches were tailored to clinical and healthcare system needs rather than applied uniformly across all cases; therefore, slight differences were observed in the types of imaging used for each case. CONCLUSIONS: COs can lead to vision-threatening complications, particularly choroidal neovascularization, which responds well to anti-VEGF therapy. Multimodal imaging is essential for accurate diagnosis and disease monitoring. Early recognition and long-term follow-up are crucial for optimizing visual outcomes.