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Multiple Intravitreal Ranibizumab Injections for Persistant Choroidal Neovascularization Associated with Presumed Ocular Histoplasmosis Syndrome

View Article: PubMed Central - PubMed

ABSTRACT

Presumed ocular histoplasmosis syndrome (POHS) is a clinical entity that is characterized by small, round, discrete, macular or mid peripheral atrophic (punched out) chorioretinal lesions (histo spots), peripapillary scarring, choroidal neovascularization (CNV), and the absence of anterior uveitis and vitritis. Diagnosis of this disorder is based upon characteristic clinical findings and a positive histoplasmin skin test or residence in an endemic region for Histoplasma capsulatum. There is no active systemic disease during diagnosis of POHS. Disciform scarring and macular CNV secondary to POHS is a well-known complication which leads to loss of visual acuity or visual disturbance. Without therapy, the visual prognosis in these patients is unfavorable. Submacular surgery, radiation, steroids, photodynamic therapy, and most recently anti-vascular endothelial growth factor therapy are current therapeutic options for this condition. We report a case with persistent CNV secondary to POHS in a middle-aged woman with moderate myopia and the clinical course of treatment with multiple intravitreal ranibizumab (Lucentis®, Novartis) injections.

No MeSH data available.


Related in: MedlinePlus

Optical coherence tomography shows intraretinal and subretinal fluid due to choroidal neovascularization in the left eye
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f4: Optical coherence tomography shows intraretinal and subretinal fluid due to choroidal neovascularization in the left eye

Mentions: A 50-year-old female patient presented to our clinic with vision loss in her left eye that she noticed 3 months earlier. She had refractive errors of -3.50 (-1.25x135) in the right eye and -4.00 (-1.00x180) in the left eye. Her best corrected visual acuity (BCVA) was 1.0 in the right eye and 0.6 in the left eye. Anterior segment examination and intraocular pressure measured by Goldmann applanation tonometry were normal in both eyes. Fundus examination with 90-D lens revealed peripapillary atrophy and peripheral tigroid fundus in both eyes. Furthermore, tilted optic disc was observed in the right eye, while lesions consistent with macular CNV and a few small, discrete mid-peripheral chorioretinal scars were observed in the left eye (Figures 1 and 2). Fundus fluorescein angiography examination revealed juxtafoveal leakage consistent with classic CNV in the left eye (Figure 3). Optical coherence tomography revealed intraretinal and subretinal fluid due to CNV in the left eye (Figure 4). A detailed history was obtained and it was learned that the patient had a pet bird. She was diagnosed with POHS based on typical clinical findings. Intravitreal ranibizumab therapy was recommended to treat the CNV. During 1.5 years of follow-up, a total of 5 ranibizumab (Lucentis®, Novartis) injections were applied, with the first 3 administered once a month over the first 3 months. After the injections, the CNV regressed leaving a subretinal scar, and the patient’s BCVA in the left eye remained at 0.3 (Figure 5).


Multiple Intravitreal Ranibizumab Injections for Persistant Choroidal Neovascularization Associated with Presumed Ocular Histoplasmosis Syndrome
Optical coherence tomography shows intraretinal and subretinal fluid due to choroidal neovascularization in the left eye
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5384118&req=5

f4: Optical coherence tomography shows intraretinal and subretinal fluid due to choroidal neovascularization in the left eye
Mentions: A 50-year-old female patient presented to our clinic with vision loss in her left eye that she noticed 3 months earlier. She had refractive errors of -3.50 (-1.25x135) in the right eye and -4.00 (-1.00x180) in the left eye. Her best corrected visual acuity (BCVA) was 1.0 in the right eye and 0.6 in the left eye. Anterior segment examination and intraocular pressure measured by Goldmann applanation tonometry were normal in both eyes. Fundus examination with 90-D lens revealed peripapillary atrophy and peripheral tigroid fundus in both eyes. Furthermore, tilted optic disc was observed in the right eye, while lesions consistent with macular CNV and a few small, discrete mid-peripheral chorioretinal scars were observed in the left eye (Figures 1 and 2). Fundus fluorescein angiography examination revealed juxtafoveal leakage consistent with classic CNV in the left eye (Figure 3). Optical coherence tomography revealed intraretinal and subretinal fluid due to CNV in the left eye (Figure 4). A detailed history was obtained and it was learned that the patient had a pet bird. She was diagnosed with POHS based on typical clinical findings. Intravitreal ranibizumab therapy was recommended to treat the CNV. During 1.5 years of follow-up, a total of 5 ranibizumab (Lucentis®, Novartis) injections were applied, with the first 3 administered once a month over the first 3 months. After the injections, the CNV regressed leaving a subretinal scar, and the patient’s BCVA in the left eye remained at 0.3 (Figure 5).

View Article: PubMed Central - PubMed

ABSTRACT

Presumed ocular histoplasmosis syndrome (POHS) is a clinical entity that is characterized by small, round, discrete, macular or mid peripheral atrophic (punched out) chorioretinal lesions (histo spots), peripapillary scarring, choroidal neovascularization (CNV), and the absence of anterior uveitis and vitritis. Diagnosis of this disorder is based upon characteristic clinical findings and a positive histoplasmin skin test or residence in an endemic region for Histoplasma capsulatum. There is no active systemic disease during diagnosis of POHS. Disciform scarring and macular CNV secondary to POHS is a well-known complication which leads to loss of visual acuity or visual disturbance. Without therapy, the visual prognosis in these patients is unfavorable. Submacular surgery, radiation, steroids, photodynamic therapy, and most recently anti-vascular endothelial growth factor therapy are current therapeutic options for this condition. We report a case with persistent CNV secondary to POHS in a middle-aged woman with moderate myopia and the clinical course of treatment with multiple intravitreal ranibizumab (Lucentis®, Novartis) injections.

No MeSH data available.


Related in: MedlinePlus