Purpose:To describe a case of choroidal osteoma with choroidal neovascularization (CNV) that was successfully treated with two intravitreal injections of bevacizumab (IVB).Design and methods:Case report on a 12-year-old Japanese girl who presented with a sudden decrease in vision in her left eye. At the first visit, 2 days after the onset of her symptoms, her visual acuity (VA) in her left eye was 0.2. Ophthalmoscopy showed a hemorrhage of 5 disc diameters under the retinal pigment epithelium and a serous retinal detachment at the posterior pole of the left eye. These findings were confirmed by optical coherence tomography. Fluorescein angiography (FA) and indocyanine green angiography (ICGA) showed several points of leakage around the fovea, which suggested a CNV. From these findings, the patient was diagnosed with choroidal osteoma with a CNV. The submacular hemorrhage was from the CNV associated with the choroidal osteoma. We treated her with two injections of 1.25 mg/0.05 mL IVB with a 4-month interval.Results:The patient’s VA in her left eye improved to 0.7, and this vision was maintained for 4 years. The CNV disappeared in the FA and ICGA images and no recurrence was observed after 4 years.Conclusion:Our findings indicate that IVB is effective in resolving CNV in eyes with an osteoma and prevents a decrease of vision in eyes with a choroidal osteoma with a CNV.

Recent advances in the treatment of central retinal artery occlusion (CRAO) have resulted in a relatively good prognosis, but few studies have been reported. In the present study, electroretinography (ERG) was used to evaluate visual function recovery in 15 cases of CRAO. All patients were treated with ocular massage, intravenous urokinase and hyperbaric oxygenation. Of 15 cases, 8 had improved vision after treatment. A single flash ERG of 40 J from a xenon lamp was recorded before and during treatment. For ERG evaluation, the a- and b-wave amplitudes and the b/a wave amplitude ratio were analyzed. As control, the nonaffected eye of each patient was used. Before treatment, no significant difference was found in the a-wave amplitude between the two eyes, while a significant attenuation was found in the b-wave of the affected eye (p < 0.01). The b/a ratio was 0.73 ± 0.04 (mean ± SE) in the affected eye group and 1.08 ± 0.03 in the nonaffected eye group. It was significantly higher (p < 0.01 in eyes with improved visual acuity (0.83 ± 0.03) than in those with unimproved visual acuity (0.62 ± 0.05). The b-wave amplitude increased in accordance with visual improvement. We could thus demonstrate the temporal changes of ERG before and after treatment and show their correlation with the visual prognosis in patients with CRAO.

Although multicentric Castleman disease is a rare but life-threatening disease, eye complications are extremely uncommon. We present a case of refractory uveitis accompanied with Castleman disease successfully treated with tocilizumab. A 58-year-old man with Castleman disease was introduced for refractory uveitis to Chiba University Hospital. Large cells were detected in the anterior chamber and increased vascular permeability of retinal vessels has been found in both eyes. Although the patient was treated with oral and eye drop steroid treatment, the uveitis symptoms had not decreased. The serum levels of CRP and IL-6 were increased. The level of IL-6 concentration in the anterior chamber was the same as the serum level of IL-6. The humanized anti-IL-6 receptor-antibody (tocilizumab) was administrated for the patient because of poor general condition. After tocilizumab treatment, large cells in the anterior chamber were undetectable and vascular permeability was improved in FA. The serum levels of CRP and IL-6 decreased and the general condition improved. The side effect of tocilizumab was not observed during the treatment. Tocilizumab treatment was significantly effective for uveitis accompanied with Castleman disease. Although it is extremely rare, uveitis accompanied with Castleman disease may be one of the hallmarks to consider tocilizumab treatment.

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