eMedicine Specialties > Ophthalmology > Retina

Presumed Ocular Histoplasmosis Syndrome: Follow-up

Author: Lihteh Wu, MD, Consulting Surgeon, Department of Ophthalmology, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Coauthor(s): Teodoro Evans, MD, Retina Fellow, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Contributor Information and Disclosures

Updated: Jul 24, 2007

Follow-up

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.

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.
    • 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 44% of cases.
    • How to effectively manage these recurrences is unclear.

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).
  • 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.
  • Of eyes with juxtafoveal CNV, 12% had severe visual loss compared to 28% of eyes that were observed.
  • 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.7 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.

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.
 


More on Presumed Ocular Histoplasmosis Syndrome

Overview: Presumed Ocular Histoplasmosis Syndrome
Differential Diagnoses & Workup: Presumed Ocular Histoplasmosis Syndrome
Treatment & Medication: Presumed Ocular Histoplasmosis Syndrome
Follow-up: Presumed Ocular Histoplasmosis Syndrome
References
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References

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  2. Atebara NH, Thomas MA, Holekamp NM, Mandell BA, Del Priore LV. Surgical removal of extensive peripapillary choroidal neovascularization associated with presumed ocular histoplasmosis syndrome. Ophthalmology. Sep 1998;105(9):1598-605. [Medline].

  3. Baskin MA, Jampol LM, Huamonte FU, Rabb MF, Vygantas CM, Wyhinny G. Macular lesions in blacks with the presumed ocular histoplasmosis syndrome. Am J Ophthalmol. Jan 1980;89(1):77-83. [Medline].

  4. Berger AS, Conway M, Del Priore LV, Walker RS, Pollack JS, Kaplan HJ. Submacular surgery for subfoveal choroidal neovascular membranes in patients with presumed ocular histoplasmosis. Arch Ophthalmol. Aug 1997;115(8):991-6. [Medline].

  5. Callanan D, Fish GE, Anand R. Reactivation of inflammatory lesions in ocular histoplasmosis. Arch Ophthalmol. Apr 1998;116(4):470-4. [Medline].

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  7. Fine SL, Wood WJ, Isernhagen RD, Singerman LJ, Bressler NM, Folk JC, et al. Laser treatment for subfoveal neovascular membranes in ocular histoplasmosis syndrome: results of a pilot randomized clinical trial. Arch Ophthalmol. Jan 1993;111(1):19-20. [Medline].

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Further Reading

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Keywords

POHS, ocular histoplasmosis, peripheral atrophic chorioretinal scars, peripapillary scarring, maculopathy, Histoplasma capsulatum, H capsulatum, histoplasmin skin testing, fungal infection, macular choroidal neovascularization, macular CNV, vision loss

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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, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Teodoro Evans, MD, Retina Fellow, Vitreo-Retinal Section, Instituto De Cirugia Ocular, Costa Rica
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
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.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting

CME Editor

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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