Saturday, November 19, 2011

Classic Findings


This set of color fundus images shows the classic triad of a retinal findings in what disease?

(Hint: does the Ohio River Valley sound like a familiar prompt from board prep?)

3 comments:

  1. I got it from Ohio River Valley hint. Which of these signs carry the worst prognosis? How would a patient with this be treated? Amphotericin B or would this require surgery?

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  2. I may have to bring the expert in on this!

    Interestingly, the disease entity is called Presumed Ocular Histoplasmosis Syndrome (POHS) because the triad is well established in association with exposure to Histoplasma capsulatum though no organisms have been successfully cultured from affected eyes. The disciform scar in the macula, which causes the significant visual loss is due to choroidal neovascularization (CNV). I would defer to the retina expert on the roll of anti-VEGF treatment, but that's almost always the answer in retina! Steroids have also been reported in small series to be somewhat effective. It seems, however, that anti-fungals are of limited benefit.

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  3. The peripheral lesions and peripapillary lesions aid in the diagnosis but really have no significant role in the disease. It is the macular lesion which can become active, usually with associated choroidal neovascularization. The current standard of care would be anti-vefg intravitreal injections; sometimes photodynamic therapy (PDT with vertoporfin) or thermal laser (for extrafoveal lesions) might be used.

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