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Presumed ocular histoplasmosis syndrome

AI overview

Presumed ocular histoplasmosis syndrome (POHS) is a syndrome affecting the eye, characterized by peripheral atrophic chorioretinal scars, atrophy or scarring adjacent to the optic disc and maculopathy.

Key points
  • Vision loss in POHS is caused by choroidal neovascularization.
    source quote
    The loss of vision in POHS is caused by choroidal neovascularization .
  • The relationship of POHS to Histoplasma capsulatum is controversial and questioned by medical professionals.
    source quote
    the "presumed" relationship of POHS to Histoplasma capsulatum is controversial and has been questioned by a number of medical professionals.
  • The fungus has rarely been isolated from cases with POHS.
    source quote
    The fungus has rarely been isolated from cases with POHS
  • POHS has been found in locations where histoplasmosis is rare.
    source quote
    the condition has also been found in locations where histoplasmosis is rare
  • There appears to be a relationship between POHS and tobacco smoking.
    source quote
    there appears to be a relationship with tobacco smoking .
  • Acute ocular histoplasmosis is completely distinct from POHS and may rarely occur in immunodeficiency.
    source quote
    Completely distinct from POHS, acute ocular histoplasmosis may rarely occur in immunodeficiency .
Symptoms
  • POHS causes loss of vision.
    source quote
    The loss of vision in POHS is caused by choroidal neovascularization .
  • Maculopathy is a feature of POHS.
    source quote
    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 .
Diagnosis
  • Diagnosis is based on a clinical triad of multiple white atrophic choroidal scars, peripapillary pigment changes, and maculopathy caused by choroidal neovascularization.
    source quote
    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 .
  • Fluorescein angiography is usually performed for diagnosis and follow-up.
    source quote
    Fluorescein angiography is usually performed for diagnosis and follow-up of patients with POHS.
Treatment
  • Treatment requires careful consideration of angiographic findings when choroidal neovascular membrane is suspected.
    source quote
    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 should be consulted for proper management.
    source quote
    A vitreo-retinal specialist (an ophthalmologist specialized in treatment of retinal diseases) should be consulted for proper management of the case.
  • POHS has been treated with laser, anti-vascular endothelial growth factors, and photodynamic therapy.
    source quote
    Presumed ocular histoplasmosis syndrome and age-related macular degeneration (AMD) have been successfully treated with laser, anti-vascular endothelial growth factors and photodynamic therapy .
  • Anti-VEGF is used because VEGF is one of the causes for the growth of abnormal vessels.
    source quote
    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.
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Presumed ocular histoplasmosis syndrome
Retinal photograph of ocular histoplasmosis
SpecialtyOphthalmology

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.

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. [citation needed]

Completely distinct from POHS, acute ocular histoplasmosis may rarely occur in immunodeficiency.[1][2]

Despite its name, the "presumed" relationship of POHS to Histoplasma capsulatum is controversial and has been questioned by a number of medical professionals.[3][4][5] The fungus has rarely been isolated from cases with POHS,[6][medical citation needed] the condition has also been found in locations where histoplasmosis is rare,[7] and there appears to be a relationship with tobacco smoking.[medical citation needed]

Fluorescein angiography is usually performed for diagnosis and follow-up of patients with POHS.[citation needed]

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.[citation needed]

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.[citation needed]

  1. ↑ Macher A, Rodrigues MM, Kaplan W, Pistole MC, McKittrick A, Lawrinson WE, Reichert CM (1985). "Disseminated bilateral chorioretinitis due to Histoplasma capsulatum in a patient with the acquired immunodeficiency syndrome". Ophthalmology. 92 (8): 1159–64. doi:10.1016/s0161-6420(85)33921-0. PMID 2413418.
  2. ↑ 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.
  3. ↑ 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. S2CID 43761401.
  4. ↑ 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. S2CID 25507234.
  5. ↑ Woods AC; Wahlen HE (1959). "The probable role of benign histoplasmosis in the etiology of granulomatous uveitis". Transactions of the American Ophthalmological Society. 57: 318–347. PMC 1316339. PMID 16693576.
  6. ↑ Presumed Ocular Histoplasmosis Syndrome
  7. ↑ 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.
  8. 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. S2CID 44374405.