Sclerochoroidal calcifications

Author: Catarina Rodrigues (Portugal)

Co-authors: Catarina Rodrigues, Miguel Leitão, Rita Guerra Pinto, Manuela Martins

Purpose

To report on two cases of sclerochoroidal calcifications (SCC) in two patients with no relevant past medical history. Review of existing literature.

Setting/Venue

Case report of two patients with an incidental finding of sclerochoroidal calcifications.

Methods

A 72 year-old female and a 81-year-old male were referred to our department due to bilateral fundus abnormalities discovered on routine ophthalmic evaluation. Both had no systemic or ocular complaints, no relevant previous medical history and no long-term medication. A comprehensive ophthalmic examination was done, including best corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, ocular ultrasonography and retinal multimodal imaging with fluorescein angiography (FA), Autofluorescence (FAF) and optical coherence tomography (OCT). Laboratory investigations for calcium metabolism abnormalities have been undertaken.

Results

Both patients had unremarkable anterior segment examination. In both cases, posterior segment examination revealed two large elevated yellow white subretinal lesions seen along the superotemporal vascular arcade in both eyes, with a few smaller satellite lesions surrounding each one of the larger lesions. OCT showed scleral masses causing distortion of the overlying structures. There was no associated subretinal fluid or significant retinal pigment epithelium (REP) changes. B-scan ultrasonography confirmed elevated solid lesions with high internal reflectivity and posterior shadowing, consistent with calcium deposits. On FAF pictures the lesions showed hyperautofluorescence and fluorescein angiography disclosed early and late hyperfluorescence staining corresponding to the lesions. The patients were diagnosed with bilateral sclerochoroidal calcification and a systemic work-up is being conducted to exclude disturbances of calcium metabolism.

Conlusions

Sclerochoroidal calcification is a benign and uncommon condition, commonly related to calcium, potassium or magnesium metabolic abnormalities, in which calcium salts are deposited within the scleral and choroidal leading to minimally elevated mass that can mimic a tumor. Classically the lesions are found along the superotemporal area, between the equator and the retinal vascular arcades, although the reason for this is unclear. In hypercalcemia, in other organs calcium is typically deposited in the vasculature. Sclerochoroidal calcification is typically an incidental finding as it usually has no impact on visual acuity neither is associated with visual symptoms. It is important to recognise this diagnosis in order to avoid unnecessary and resource-consuming investigations for tumoral lesions, as well as to prompt investigation of underlying endocrinological disorders which may be associated with this condition and may require systemic therapy

Financial Disclosure

No financial disclosure

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