Prostatic adenocarcinoma metastatic to the anterior uveal tract.

muscle cells. The presence of osteoclasts in our case is novel. The reason for the development of subretinal neovascular membranes in eyes with choroidal osteoma is unknown. One hypothesis is that the thinned, degenerated RPE overlying the osteoma allows the growth of new blood vessels. Our observation that osteoclasts are present in the neovascular membrane raises the possibility that neovascular membranes in this condition might represent an extension of the osteoma. The therapeutic value of surgical removal of choroidal neovascular membranes has been studied. Excision of type 1 membranes, such as in age-related macular degeneration, typically involves the removal of the overlying RPE and generally results in poor visual acuity. Type 2 membranes may be more amenable to surgical removal. A recent report of a series of surgically removed type 2 subfoveal neovascular membranes documented substantial visual improvement in 11 of 17 patients aged 55 and younger. It has been hypothesized that the better surgical prognosis in patients with type 2 membranes is a result of relative sparing of the RPE. In our case, a type 2 subfoveal neovascular membrane was successfully surgically removed, which resulted in relatively stable visual acuity. This occurred despite the fact that numerous pigmented cells, possibly RPE, were included in the excised tissue. It is unclear whether these pigmented cells were part of the original RPE monolayer or were a reactive proliferation in response to the osteoma. The present case suggests that surgical intervention may be considered as one treatment option for patients with subfoveal choroidal neovascular membranes associated with choroidal osteomas. However, its effectiveness compared with observation of new modalities such as photodynamic therapy is unknown. A recent report described the results of photodynamic therapy of an extrafoveal choroidal neovascular membrane in association with a choroidal osteoma. There was a substantial reduction in the size of the neovascular membrane and no decrease in visual acuity. To our knowledge, there have been no previous reports describing subfoveal membranes in patients with a choroidal osteoma treated with surgical or photodynamic therapy. It is too soon to tell whether surgical excision is superior or inferior to other therapies.