Presumed ocular histoplasmosis syndrome: Difference between revisions
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==Overview== | |||
'''Presumed ocular histoplasmosis syndrome''' ('''POHS''') is a syndrome affecting the eye, which is characterized by peripheral atrophic chorioretinal scars, atrophy or scarring adjacent to the [[optic disc]] and [[maculopathy]]. | |||
The loss of vision in POHS is caused by [[choroidal neovascularization]]. | |||
[[File:640px-Presumed ocular histoplasmosis syndrome-11192007.png|300px|centre|Retinal photograph of ocular histoplasmosis]] | |||
==Causes== | |||
Despite its name, the "presumed" relationship of POHS to ''[[Histoplasma capsulatum]]'' is controversial.<ref>Thuruthumaly, C; Yee, D. C.; Rao, P. K. (2014). "Presumed ocular histoplasmosis". Current Opinion in Ophthalmology 25 (6): 508–12. doi:10.1097/ICU.0000000000000100. PMID 25237930</ref><ref>Nielsen, J. S.; Fick, T. A.; Saggau, D. D.; Barnes, C. H. (2012). "Intravitreal anti-vascular endothelial growth factor therapy for choroidal neovascularization secondary to ocular histoplasmosis syndrome". Retina 32 (3): 468–72. doi:10.1097/IAE.0b013e318229b220. PMID 21817958</ref> The fungus has rarely been isolated from cases with POHS,<ref>[http://www.pohs.nl/overpohs.html] Presumed Ocular Histoplasmosis Syndrome</ref>{{medical citation needed|date=November 2014}} the condition has also been found in locations where [[histoplasmosis]] is rare,<ref name="DithmarHolz2008">{{cite book|author1=Stefan Dithmar|author2=Frank Gerhard Holz|title=Fluorescence Angiography in Ophthalmology|url=http://books.google.com/books?id=ebTzQKwQuNEC&pg=PA168|accessdate=29 June 2010|date=28 April 2008|publisher=Springer|isbn=978-3-540-78359-6|pages=168–}}</ref> and there appears to be a relationship with tobacco smoking.{{medical citation needed|date=November 2014}} | |||
== Presentation == | |||
The diagnosis of POHS is based on the clinical triad of multiple white, atrophic choroidal | |||
scars, peripapillary pigment changes (dark spots around optic disc of the eye), and a maculopathy caused by [[choroidal neovascularization]]. | |||
Completely distinct from POHS, acute ocular histoplasmosis may rarely occur in immunodeficiency.<ref>Macher, A; Rodrigues, M. M.; Kaplan, W; Pistole, M. C.; McKittrick, A; Lawrinson, W. E.; Reichert, C. M. (1985). "Disseminated bilateral chorioretinitis due to Histoplasma capsulatum in a patient with the acquired immunodeficiency syndrome". Ophthalmology 92 (8): 1159–64. PMID 2413418</ref><ref>{{Cite journal | pmid = 10768335| year = 2000| author1 = Gonzales| first1 = C. A.| title = Endogenous endophthalmitis caused by Histoplasma capsulatum var. Capsulatum: A case report and literature review| journal = Ophthalmology| volume = 107| issue = 4| pages = 725–9| last2 = Scott| first2 = I. U.| last3 = Chaudhry| first3 = N. A.| last4 = Luu| first4 = K. M.| last5 = Miller| first5 = D| last6 = Murray| first6 = T. G.| last7 = Davis| first7 = J. L. | doi=10.1016/s0161-6420(99)00179-7}}</ref> | |||
==Diagnosis== | |||
[[Fluorescein angiography]] is usually performed for diagnosis and follow-up of patients with POHS. | |||
==Treatment== | |||
Treatment requires careful consideration of angiographic findings when a choroidal neovascular membrane is suspected which is a condition that responds to treatment. A vitreo-retinal specialist (an ophthalmologist specialized in treatment of retinal diseases) should be consulted for proper management of the case. | |||
Presumed ocular histoplasmosis syndrome and [[age-related macular degeneration]] (AMD) have been successfully treated with laser, [[Angiogenesis inhibitor|anti-vascular endothelial growth factors]] and photodynamic therapy. [[Ophthalmologists]] are using anti-vascular endothelial growth factors to treat AMD and similar conditions since research indicates that vascular endothelial growth factor (VEGF) is one of the causes for the growth of the abnormal vessels that cause these conditions. | |||
== See also== | |||
* [[Uveitis]] | |||
* There is a Dutch website about POHS. ( http://www.pohs.nl ) | |||
==References== | |||
{{reflist|refs | |||
<ref name="pmid19898179">{{cite journal |vauthors=Ehrlich R, Ciulla TA, Maturi R, etal |title=Intravitreal bevacizumab for choroidal neovascularization secondary to presumed ocular histoplasmosis syndrome |journal=Retina (Philadelphia, Pa.) |volume=29 |issue=10 |pages=1418–23 |year=2009 |pmid=19898179 |doi=10.1097/IAE.0b013e3181babdf1 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0275-004X&volume=29&issue=10&spage=1418}}</ref> | |||
}} | |||
{{Eye pathology}} | |||
[[Category:Diseases of the eye and adnexa]] | |||
==External links== | ==External links== | ||
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[[Category: | [[Category:Ophthalmology]] | ||
[[Category:Optometry]] | [[Category:Optometry]] | ||
{{WikiDoc Help Menu}} | {{WikiDoc Help Menu}} | ||
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Latest revision as of 16:37, 31 January 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Associate Editor(s)-in-Chief: Jyostna Chouturi, M.B.B.S [3]
Overview
Presumed ocular histoplasmosis syndrome (POHS) is a syndrome affecting the eye, which is characterized by peripheral atrophic chorioretinal scars, atrophy or scarring adjacent to the optic disc and maculopathy. The loss of vision in POHS is caused by choroidal neovascularization.
Causes
Despite its name, the "presumed" relationship of POHS to Histoplasma capsulatum is controversial.[1][2] The fungus has rarely been isolated from cases with POHS,[3][medical citation needed] the condition has also been found in locations where histoplasmosis is rare,[4] and there appears to be a relationship with tobacco smoking.[medical citation needed]
Presentation
The diagnosis of POHS is based on the clinical triad of multiple white, atrophic choroidal scars, peripapillary pigment changes (dark spots around optic disc of the eye), and a maculopathy caused by choroidal neovascularization.
Completely distinct from POHS, acute ocular histoplasmosis may rarely occur in immunodeficiency.[5][6]
Diagnosis
Fluorescein angiography is usually performed for diagnosis and follow-up of patients with POHS.
Treatment
Treatment requires careful consideration of angiographic findings when a choroidal neovascular membrane is suspected which is a condition that responds to treatment. A vitreo-retinal specialist (an ophthalmologist specialized in treatment of retinal diseases) should be consulted for proper management of the case.
Presumed ocular histoplasmosis syndrome and age-related macular degeneration (AMD) have been successfully treated with laser, anti-vascular endothelial growth factors and photodynamic therapy. Ophthalmologists are using anti-vascular endothelial growth factors to treat AMD and similar conditions since research indicates that vascular endothelial growth factor (VEGF) is one of the causes for the growth of the abnormal vessels that cause these conditions.
See also
- Uveitis
- There is a Dutch website about POHS. ( http://www.pohs.nl )
References
- ↑ Thuruthumaly, C; Yee, D. C.; Rao, P. K. (2014). "Presumed ocular histoplasmosis". Current Opinion in Ophthalmology 25 (6): 508–12. doi:10.1097/ICU.0000000000000100. PMID 25237930
- ↑ Nielsen, J. S.; Fick, T. A.; Saggau, D. D.; Barnes, C. H. (2012). "Intravitreal anti-vascular endothelial growth factor therapy for choroidal neovascularization secondary to ocular histoplasmosis syndrome". Retina 32 (3): 468–72. doi:10.1097/IAE.0b013e318229b220. PMID 21817958
- ↑ [1] Presumed Ocular Histoplasmosis Syndrome
- ↑ Stefan Dithmar; Frank Gerhard Holz (28 April 2008). Fluorescence Angiography in Ophthalmology. Springer. pp. 168–. ISBN 978-3-540-78359-6. Retrieved 29 June 2010.
- ↑ Macher, A; Rodrigues, M. M.; Kaplan, W; Pistole, M. C.; McKittrick, A; Lawrinson, W. E.; Reichert, C. M. (1985). "Disseminated bilateral chorioretinitis due to Histoplasma capsulatum in a patient with the acquired immunodeficiency syndrome". Ophthalmology 92 (8): 1159–64. PMID 2413418
- ↑ Gonzales, C. A.; Scott, I. U.; Chaudhry, N. A.; Luu, K. M.; Miller, D; Murray, T. G.; Davis, J. L. (2000). "Endogenous endophthalmitis caused by Histoplasma capsulatum var. Capsulatum: A case report and literature review". Ophthalmology. 107 (4): 725–9. doi:10.1016/s0161-6420(99)00179-7. PMID 10768335.
- ↑ Ehrlich R, Ciulla TA, Maturi R, et al. (2009). "Intravitreal bevacizumab for choroidal neovascularization secondary to presumed ocular histoplasmosis syndrome". Retina (Philadelphia, Pa.). 29 (10): 1418–23. doi:10.1097/IAE.0b013e3181babdf1. PMID 19898179.