Metastatic sclerochorioidal calcifications in a patient with primary hyperparathyroidism
I. Flögel, A. Klein, G. Langmann
Purpose: Tiny metastatic calcifications in the eye have been described in patients with hyperparathyroidism, pseudohypoparathyroidism, vitamin D intoxication, hypophosphatemia, sarcoidosis and chronic renal failure. We have recognized metastatic sclerochoroidal calcification which caused large bilateral tumors at the posterior pole.
Patients and methods: We report a case of a 65 year old male with primary hyperparathyroidism, chronic renal failure, elevated levels of serum calcium and parathyroid hormone. He presented for routine ophthalmoscopic examination.
Results: Visual acuity was 6/10 on both eyes. Fundus examination revealed a bilateral yellow-white tumorlike, large, irregularly thickened lesion in the macular area. Fluorescein angiography demonstrated diffuse hyperfluorescence with small areas of hypofluorescence in the early phase and reduction of these phenomens in the late phase. In the A-scan echography the lesion showed a high inner reflectivity, with a thickness of 4,6 mm on the right eye and 3,6 mm on the left eye; B-scan echography demonstrated shadowing in the orbit. Computer tomography and MRI showed bilateral sclerochoroidal calcification in the macular area of both eyes.
Discussion: Metastatic sclerochoroidal calcification is an uncommon and poorly recognized entity. Clinically it is defined as the deposition of calcium salt in normal tissue because of abnormal calcium or phosphate metabolism. Contrary to idiopathic sclerochorioidal calcification where the lesions are usually located in the midperipheral fundus, the bilateral tumor of our patient involved the macular area with nearly normal visual acuity. Osteoma is a further differential diagnostic consideration. Sex distribution, age and localization are important features that can separate sclerochorioidal calcification from osteoma.
Univ. Augenklinik Graz, Auenbruggerplatz 4, A- 8036 Graz