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Idiopathic sclerochoroidal calcification
  1. C A Cooke,
  2. C McAvoy,
  3. R Best
  1. Department of Ophthalmology, Royal Victoria Hospital, Belfast, Northern Ireland, UK
  1. Correspondence to: Dr Carole A Cooke

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Sclerochoroidal calcification is a relatively rare condition characterised by yellow-white irregular subretinal lesions usually in the superotemporal mid-periphery of the fundus. It is usually asymptomatic and has a classic clinical appearance. Most cases are idiopathic but a few reports have associated this condition with abnormalities of electrolytes.1–3 We present three cases of idiopathic sclerochoroidal calcification.

Case reports

Case 1

A 71 year old white woman was referred by her optician after attending for routine glasses update. On questioning she did complain of a “slight blurring of vision” gradually for several months. She had a history of left amblyopia. Her medical history included asthma, osteoarthritis, lymphoedema, fibromyalgia, and hiatus hernia. Her only medications were inhalers and paracetamol. She had previously taken calcium supplements. Her visual acuities were 6/6 in the right eye and 6/12 in the left eye with a hypermetropic correction. She had early cortical lens opacities and no vitritis. Both fundi revealed minimally elevated yellow areas in the choroid along the superotemporal arcades (Fig 1A).

Figure 1

Case 1 (A) Elevated yellow areas along the supertemporal arcades bilaterally and demonstration of autofluorescence of these lesions. (B) Ultrasound scan showing the lesions to be highly reflective with orbital shadowing.

The patient had haematological investigations revealing a normal full blood picture, urea and electrolytes, ACE level, urate, liver function tests, bone profile, immunoglobulins, erythrocyte sedimentation rate (ESR), and C reactive protein. She also had a chest x ray which was unremarkable. Her fundal photography showed autofluorescence of these lesions and ultrasound scanning aided the diagnosis in that the lesions were highly reflective with orbital shadowing (Fig 1B).

Case 2

An 82 year old white woman was referred by her optician complaining of a gradual reduction in vision bilaterally. She had recently been diagnosed with polymyalgia rheumatica and was well controlled with oral prednisolone. She had no headaches. Her medical history included oesophagitis and hiatus hernia and cervical spondylosis. Her unaided visual acuity was 6/12 right eye improving to 6/9 with pinhole, and 6/18 left eye improving to 6/12 with pinhole. She had bilateral nucleosclerotic cataracts and both fundi revealed numerous pale elevated lesions clustered around the superotemporal and inferotemporal arcades (Fig 2A).

Figure 2

Case 2 (A) Pale yellow elevated lesions in the mid-periphery clustered around the superotemporal arcade. (B) Ultrasound of lesions revealing that they are areas of calcification with high reflectivity.

Haematological investigations and chest x ray were unremarkable. Ultrasound scanning revealed that these were areas of calcification with high reflectivity (Fig 2B).

Case 3

A 71 year old man attended routinely for review 2 weeks after cataract extraction. He had no past medical history and vision was 6/9 right eye and 6/6 left eye. He was noted to have a small optic disc haemorrhage coincidentally and therefore dilated fundal examination was performed. He had bilateral pale yellow elevated lesions along the superotemporal arcades and also nasally in both fundi. Again electrolytes were investigated and were within the normal range.

Comment

Sclerochoroidal calcification has been described in the literature as an uncommon condition found usually in older white patients.3 Patients have been unnecessarily investigated in the past and even treated for tumours unnecessarily.4 Calcification can be dystrophic or metastatic but in these idiopathic cases it is the former. The calcification is believed to be deposited at the sites of insertions of the oblique extraocular muscles in a similar way that Cogan scleral plaques are calcification at the insertions of the horizontal recti muscles.5 Reports have been made of sclerochoroidal calcification associated with Bartter syndrome,1 Gitelman syndrome,2 hyperparathyroidism, and hypomagnesaemia.3 It is important to exclude any electrolyte abnormality when a patient presents with this condition, but prolonged investigations are unnecessary. Autofluorescence and ultrasound appearances are very useful to diagnose this condition. Patients rarely develop visual disturbance with sclerochoroidal calcification, but infrequent follow up is advised as cases of associated choroidal neovascular membranes and serous detachments with the lesions have been documented.6

Acknowledgments

ALCON kindly sponsored the publication costs of the figures.

References

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