Anita G Prasad1, Russell N Van Gelder. 1. Department of Ophthalmology and Visual Sciences, Washington University Medical School, St Louis, Missouri 63110, USA.
Abstract
PURPOSE OF REVIEW: Presumed ocular histoplasmosis syndrome remains a significant cause of visual morbidity. We review recent literature on the pathogenesis and particularly on the treatment of complications of presumed ocular histoplasmosis syndrome. RECENT FINDINGS: The pathogenesis of presumed ocular histoplasmosis syndrome remains mysterious; although some recent molecular evidence suggests a direct link between Histoplasma capsulatum and presumed ocular histoplasmosis syndrome, other reports document nearly identical disease occurring in the absence of H. capsulatum seropositivity. Treatment options have advanced rapidly in the past few years. Small case series and clinical trials suggest excellent efficacy for photodynamic therapy in the treatment of subretinal neovascularization associated with presumed ocular histoplasmosis syndrome. Preliminary studies also suggest efficacy of intravitreal corticosteroids. A large randomized controlled clinical trial failed to show efficacy for subretinal surgery in the management of presumed ocular histoplasmosis syndrome, however. SUMMARY: Despite continued debate on the etiology of presumed ocular histoplasmosis syndrome, there have been significant advances in treatment of the blinding complications of presumed ocular histoplasmosis syndrome.
PURPOSE OF REVIEW: Presumed ocular histoplasmosis syndrome remains a significant cause of visual morbidity. We review recent literature on the pathogenesis and particularly on the treatment of complications of presumed ocular histoplasmosis syndrome. RECENT FINDINGS: The pathogenesis of presumed ocular histoplasmosis syndrome remains mysterious; although some recent molecular evidence suggests a direct link between Histoplasma capsulatum and presumed ocular histoplasmosis syndrome, other reports document nearly identical disease occurring in the absence of H. capsulatum seropositivity. Treatment options have advanced rapidly in the past few years. Small case series and clinical trials suggest excellent efficacy for photodynamic therapy in the treatment of subretinal neovascularization associated with presumed ocular histoplasmosis syndrome. Preliminary studies also suggest efficacy of intravitreal corticosteroids. A large randomized controlled clinical trial failed to show efficacy for subretinal surgery in the management of presumed ocular histoplasmosis syndrome, however. SUMMARY: Despite continued debate on the etiology of presumed ocular histoplasmosis syndrome, there have been significant advances in treatment of the blinding complications of presumed ocular histoplasmosis syndrome.