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Vitreoretinal Surgery in Rare Conditions
Published in Pradeep Venkatesh, Handbook of Vitreoretinal Surgery, 2023
Foveal translocation has been performed for subfoveal choroidal neovascularization secondary to myopia, presumed ocular histoplasmosis syndrome, and ARMD. Although clinical reports on foveal translocation are few, the results showed promise. These procedures have a high risk of developing proliferative vitreoretinopathy and a torsional, binocular diplopia [when the angle of retinal rotation is large]. Owing to the success of anti-VEGF therapy in patients with neovascular AMD, this procedure is no longer considered as a necessary intervention.
Ophthalmology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
These are all rare in children but it is important to consider them in a differential diagnosis of a yellow/white lesion in the retina. Single focal lesions: these may be caused by toxoplasmosis (Fig. 7.40), toxocariasis (Fig. 7.41), candidiasis and cryptococcus. Occasionally pars planitis (‘snowbanks’ in the inferior peripheral retina) may also be seen. All of these inflammatory conditions are accompanied by vitritis, which makes the view of the fundus hazy. Multiple focal lesions: these may be caused by candidiasis, sarcoidosis, Lyme disease, choroidal pneumocystosis, presumed ocular histoplasmosis syndrome, Behçet disease, Vogt–Koyanagi–Harada (VKH) syndrome, sympathetic ophthalmitis and tuberculous choroiditis.Diffuse lesions: these may be seen in CMV retinitis (Fig. 7.42), acute retinal necrosis, herpes simplex retinitis and measles retinitis.
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).
Epidemiology and Clinical Characteristics of Presumed Ocular Histoplasmosis in Olmsted County, Minnesota
Published in Ocular Immunology and Inflammation, 2022
Timothy T. Xu, Margaret M. Reynolds, David O. Hodge, Wendy M. Smith
Presumed ocular histoplasmosis syndrome (POHS) is a clinical syndrome characterized by a triad of multifocal chorioretinal scarring, peripapillary atrophy, and choroidal neovascularization (CNV) in the absence of anterior segment and vitreous inflammation. Although its precise pathogenesis remains controversial, POHS is thought to be caused by hematogenous dissemination of Histoplasma capsulatum to the choroidal circulation.1,2H. capsulatum, the most endemic mycosis in the United States (U.S.), is found predominantly in the Midwestern U.S. along the Ohio and Mississippi River valleys in soil contaminated by bat and bird droppings and is primarily acquired through inhalation of fungal spores.2,3 Symptomatic histoplasmosis occurs in only 1% of infections, typically manifesting as pulmonary disease; rarely, extrapulmonary organ involvement and systemic dissemination may occur, particularly among immunocompromised patients.4 In Minnesota, the incidence of systemic histoplasmosis is approximately 3 to 4 cases per 100,000 persons.4,5
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.”
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.