title: Sclerochoroidal calcification: clinical manifestations and systemic associations.
abstract: BACKGROUND
  Sclerochoroidal calcification is an unusual ocular condition that is believed to be idiopathic in most cases.
  
  
  OBJECTIVE
  To describe the clinical manifestations of sclerochoroidal calcification and to investigate its possible systemic associations.
  
  
  METHODS
  This noncomparative consecutive case series included patients diagnosed as having sclerochoroidal calcification based on clinical characteristics and diagnostic test findings. We analyzed the demographic, systemic, and ocular features of 27 such patients. Systemic evaluation included tests for calcium-phosphorus metabolism in 19 patients and renal tubular hypokalemic metabolic alkalosis syndromes (Bartter or Gitelman syndrome) in 13.
  
  
  RESULTS
  All the patients were asymptomatic older (mean age, 70 years) white individuals, incidentally noted as having a choroidal lesion on routine examination. Among 38 eyes, the main referral diagnoses were choroidal metastasis in 10 eyes (26%), choroidal melanoma in 8 (21%), and choroidal nevus in 4 (11%). Sixteen patients (59%) had unilateral clinical findings, while 11 (41%) had bilateral. The Snellen visual acuity was 20/50 or better in 37 eyes (97%). Cogan scleral plaque was visible anterior to the insertion of horizontal rectus muscles in 10 eyes (26%). Among 77 foci, there were a mean of 2 foci of sclerochoroidal calcification in each eye, 41 yellow (53%), 32 yellow-white (42%), 2 white (3%), and 2 orange (3%), measuring a mean 2.6 mm in diameter and 1.1 mm in thickness. The most common locations were postequatorial in 45 (58%), along the temporal vascular arcades in 30 (39%), and in the superotemporal quadrant in 43 (56%). A-scan and B-scan ultrasonography revealed dense echoes compatible with calcium, with orbital shadowing. All the lesions remained stable in size and configuration during a mean follow-up of 38 months. One patient developed a choroidal neovascular membrane over the area of sclerochoroidal calcification. Investigations for abnormal calcium-phosphorus metabolism in 19 patients revealed primary hyperparathyroidism in 1 patient (5%). Clinical and biochemical evaluation of 13 patients demonstrated hypomagnesemia in 6 (46%). Four patients (31%) met the criteria for the diagnosis of Gitelman syndrome.
  
  
  CONCLUSIONS
  Sclerochoroidal calcification usually manifests as multiple discrete yellow placoid lesions in the midperipheral fundus of asymptomatic older white individuals. Although most cases may be idiopathic in nature, some patients may have underlying systemic disorders involving abnormal calcium-phosphorus metabolism or renal tubular hypokalemic metabolic alkalosis syndromes. All patients with sclerochoroidal calcification should be tested for these treatable systemic associations.
authors.affiliation: Oncology Service, Wills Eye Hospital, 900 Walnut St, Philadelphia, PA 19107, USA.
authors.forename: S G
authors.initials: SG
authors.lastname: Honavar
authors.forename: C L
authors.initials: CL
authors.lastname: Shields
authors.forename: H
authors.initials: H
authors.lastname: Demirci
authors.forename: J A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000471:Alkalosis / Q000097:blood / Q000175:diagnosis; D002114:Calcinosis / Q000097:blood / Q000175:diagnosis*; D002118:Calcium / Q000097:blood; D015862:Choroid Diseases / Q000097:blood / Q000175:diagnosis*; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D007008:Hypokalemia / Q000097:blood / Q000175:diagnosis; D007668:Kidney / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000097:blood; D015422:Scleral Diseases / Q000097:blood / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D010758:Phosphorus; D002118:Calcium