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Vitreoretinal Surgery in Rare Conditions
Published in Pradeep Venkatesh, Handbook of Vitreoretinal Surgery, 2023
Technical advances in vitreoretinal surgery enabled the evolution of submacular surgery for choroidal neovascular membranes. The success of submacular surgery in treating cases of presumed ocular histoplasmosis was first reported in the literature in 1991. De Juan and Machemer in 1988 had reported that their attempts at removing submacular scar by vitreoretinal surgery in patients with exudative ARMD was associated with a high incidence of proliferative vitreoretinopathy and disappointing visual results. These differences were attributed to the fact that in the latter study, a large retinotomy and less refined instrumentation were used compared with the small retinotomy and specially designed 31–36G instruments used by Thomas and colleagues. In addition, there was a difference in the aetiology and the location of the subfoveal membranes.
Basic science, investigations and lasers
Published in Mostafa Khalil, Omar Kouli, The Duke Elder Exam of Ophthalmology, 2019
Tarek Khalil, Bilal Ibrahim, Stewart Gillan, Obaid Kousha
These fungi have properties of both yeasts and filamentous fungi. Histoplasma capsulatum is a soil fungus, endemic in Mississippi and Ohio River Valleys. Transmission is via inhalation. It can cause presumed ocular histoplasmosis syndrome (POHS).
Photodynamic therapy
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Darius M Moshfeghi, Gholam A Peyman
The Verteporfin in Ocular Histoplasmosis (VOH) Study Group has yielded two reports to date (Table 69.4). In a non-comparative, prospective study, 56% and 45% of patients gained at least 7 ETDRS letters following verteporfin PDT for subfoveal CNV secondary to ocular histoplasmosis at 12- and 24-month follow-up periods, respectively.73,74
Distinct Patterns of Choroidal Lesions in Punctate Inner Choroidopathy and Multifocal Choroiditis Determined by Heatmap Analysis
Published in Ocular Immunology and Inflammation, 2022
Jong G. Park, Muhammad Sohail Halim, Gunay Uludag, Neil Onghanseng, Nripun Sredar, Yasir J. Sepah, Quan Dong Nguyen
Punctate inner choroidopathy (PIC), multifocal choroiditis (MFC), and multifocal choroiditis and panuveitis (MCP) are a group of inflammatory conditions classically characterized by multiple yellow-white lesions at the level of the choroid or retinal pigment epithelium (RPE) in the absence of systemic disease. These clinical features were first described by Nozik and Dorsch,1 who observed fundus lesions similar in appearance to presumed ocular histoplasmosis syndrome but with the distinction of cells in the anterior chamber. The condition was expanded upon by Dreyer and Gass,2 who described episodes of recurrent inflammation in these patients and coined the term “multifocal choroiditis and panuveitis.” Around the same time, Watzke et al.3 characterized patients with similar fundus findings but no evidence of inflammation as having a separate condition which they termed “punctate inner choroidopathy.”
Diagnostic and Therapeutic Challenges in Ocular Histoplasmosis – A Case Report
Published in Ocular Immunology and Inflammation, 2022
Ankush Kawali, Padmamalini Mahendradas, Srinivasan Sanjay, Prathima K. M., Jaydev Yadav, Renuka Panchagnula, Sathish K.S.
Ocular tissue biopsy was deferred in our case due to dermatological confirmation of the diagnosis and the initial treatment response to the antifungals; instead, the confocal microscopy curiously revealed multiple large cystic lesions akin to the spores appreciated on histopathology, but not confirming to be histoplasma spores due to its size.7 Histoplasma microconidia and macroconidia of different strains are known to vary from 2 to 14 µm.8 The H. capsulatum spores detected in the skin biopsy specimen of our patients were 1.5–2 µm in size, whereas the lesions on confocal microscopy appeared equal to or larger than the size of endothelium (20 µm). This was a novel finding observed in our patient when he developed iris lesions. We wonder if the histoplasma spore can acquire larger form in the anterior chamber if the lesions seen on the confocal scans were indeed histoplasma spores. This observation should be confirmed by studying more number of cases with confocal imaging. If proven, this finding can become an imaging biomarker of the disease. The treatment response ultimately had proven the diagnosis of ocular histoplasmosis.
Pediatric Inflammatory CNV: A Case Series from a Tertiary Referral Centre
Published in Ocular Immunology and Inflammation, 2020
Sudha K. Ganesh, Arshee S. Ahmed
Ten eyes of seven patients were included in the study. Their ages ranged from 7 to 18 years (mean 12.6 years). Mean follow-up was 89.6 months. Four of the patients were female whereas three were males. The diagnosis of the underlying uveitis disease was noted to be Vogt Koyanagi Harada disease (VKH) in one eye, Serpiginous Choroiditis (SC) in two eyes, Presumed ocular histoplasmosis (POHS) in two eyes, toxoplasmosis scar in two eyes, Intermediate Uveitis (IU) in one eye and panuveitis in two eyes. Three of the seven patients had bilateral CNV. Subfoveal CNV was noted in five eyes, extrafoveal CNV in three eyes, and juxtafoveal and peripapillary CNV each in one eye. (Table 1). The most common symptom was blurring of vision noticed in all eyes followed by floaters in four eyes.