A blog dedicated to providing a resource for medical students interested in all things retina. This is solely moderated by medical students and, while we take every effort to be accurate, it does not represent a definitive reference...we just want to put the FUN in fundus!
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?
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.
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.
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?
ReplyDeleteI may have to bring the expert in on this!
ReplyDeleteInterestingly, 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.
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.
ReplyDelete