Overview
Presumed ocular histoplasmosis syndrome (POHS) is a condition characterized by peripheral choroidal atrophic scars, often with associated macular neovascularization, typically resulting from prior subclinical or clinical histoplasmosis infection 23.Diagnosis
Key Diagnostic Criteria: Multiple peripheral punched-out choroidal atrophic scars, clear vitreous, and compatible macular disciform lesions 3.
Recommended Tests:
- Fluorescein angiography to identify choroidal neovascularization (CNV) 2.
- Optical coherence tomography (OCT) for detailed macular imaging 2.
Grading: Not explicitly detailed in provided abstracts; clinical assessment and imaging findings guide severity 2.Management
First-Line Treatments:
- Anti-vascular endothelial growth factor (anti-VEGF) injections for CNV management 2.
Adjunctive Treatments:
- Photodynamic therapy (PDT) may be considered in cases resistant to anti-VEGF therapy 2.
- Laser photocoagulation for certain types of CNV, though less commonly used with advent of anti-VEGF therapy 2.Special Populations
Comorbidities: No specific management differences noted for elderly or comorbid conditions in the provided abstracts 2.
Epidemiology: Higher prevalence in regions bordering the Mississippi and Ohio rivers, suggesting environmental exposure factors 2.Key Recommendations
Utilize anti-VEGF therapy as first-line treatment for patients with POHS and CNV (Evidence: Moderate 2).
Consider geographic risk factors in patient evaluation and counseling regarding environmental exposures linked to higher POHS incidence (Evidence: Moderate 2).
Regular monitoring with fluorescein angiography and OCT is essential for managing POHS and detecting CNV early (Evidence: Moderate 2).References
1 Aleci C. From international ophthalmology to space ophthalmology: the threats to vision on the way to Moon and Mars colonization. International ophthalmology 2020. link
2 Benedict K, Shantha JG, Yeh S, Beer KD, Jackson BR. Presumed ocular histoplasmosis syndrome in a commercially insured population, United States. PloS one 2020. link
3 Godfrey WA, Cross DE, Ziemianski MC, Sabates R. HLA-B7 in presumed ocular histoplasmosis maculopathy. Transplantation proceedings 1979. link