Presumed Ocular Histoplasmosis Syndrome Follow-up

  • Author: Lihteh Wu, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Apr 30, 2012
 

Further Outpatient Care

  • Most persistent and recurrent leakage occurs during the first 18 months following laser treatment.
  • Clinical examination cannot replace FA during the first 18 months following laser treatment.
  • Two weeks following laser photocoagulation, monitor a patient with a repeat FA.
    • Pay special attention to the borders of the laser treatment zone to detect any persistence.
    • If no leakage is detected, repeat the FA 4 weeks later.
    • If no leakage is detected again, obtain another FA 4-6 weeks later.
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Complications

  • After 5 years of follow-up care, the MPS reported that 26% and 33% of patients had recurrent or persistent CNV following laser photocoagulation to an extrafoveal or juxtafoveal CNV, respectively.[21, 25]
    • These recurrences tended to be toward the foveal side and were associated with visual loss.
    • In most cases, photocoagulation of recurrent CNV is indicated.
  • Laser treatment of peripapillary CNV may be complicated by thermal damage to the papillomacular bundle.
  • Surgical excision of CNV may be complicated by retinal detachment, postvitrectomy cataract, macular pucker, and macular hole.
    • Recurrence of CNV following excision is observed in 58% of cases by 24 months of follow-up.[23]
    • How to effectively manage these recurrences is unclear.
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Prognosis

  • The average interval from the onset of symptoms between the first eye and the fellow eye was 4 years. According to the MPS, 2% per year risk of developing CNV in the fellow eye exists. The risk depends on whether the fellow eye has peripapillary scarring (4% risk) or a macular atrophic spot (20-24% risk).[21]
  • The visual prognosis for patients with POHS depends on the development of CNV and its location with respect to the center of the fovea.
  • The MPS has shown that after 5 years of follow-up care, 12% of eyes with extrafoveal CNV that were photocoagulated had severe visual loss (loss of 6 lines or more) compared to 42% of eyes that were observed.[21, 25]
  • Of eyes with juxtafoveal CNV, 12% had severe visual loss compared to 28% of eyes that were observed.[26]
  • In the MPS, photocoagulation of peripapillary CNV reduced severe visual loss from 26% of control eyes to 14% of treated eyes.
  • Pilot studies of photocoagulation of subfoveal CNV by Fine et al were inconclusive.[27] The natural history of untreated subfoveal CNV shows that 14-23% of patients retain 20/40 or better visual acuity. Eyes with subfoveal CNV undergoing surgical excision were more likely to gain 20/40 if the preoperative vision was 20/100 or better.[28]
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Patient Education

  • Once diagnosed with a maculopathy secondary to POHS, the patient is asked to self-monitor each eye with a near card and an Amsler grid.
  • If a disturbance is detected, prompt examination is encouraged.
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Contributor Information and Disclosures
Author

Lihteh Wu, MD  Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica

Lihteh Wu, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Association for Research in Vision and Ophthalmology, Pan-American Association of Ophthalmology, and Retina Society

Disclosure: Nothing to disclose.

Coauthor(s)

Teodoro Evans, MD  Retina Fellow, St Michael's Hospital, University of Toronto, Canada

Disclosure: Nothing to disclose.

Specialty Editor Board

Russell P Jayne, MD  Consulting Vitreoretinal Surgeon, The Retina Center at Las Vegas

Russell P Jayne, MD is a member of the following medical societies: American Medical Association, American Society of Cataract and Refractive Surgery, and American Society of Retina Specialists

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Other; Topcon Medical Lasers Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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