Multiple Intravitreal Ranibizumab Injections for Persistant Choroidal Neovascularization Associated with Presumed Ocular Histoplasmosis Syndrome

Abstract

Presumed ocular histoplasmosis syndrome (POHS) is a clinical entity that is characterized by small, round, discrete, macular or midperipheral atrophic (punched out) chorioretinal lesions (histo spots), peripapillary scarring, choroidal neovascularization (CNV), and theabsence of anterior uveitis and vitritis. Diagnosis of this disorder is based upon characteristic clinical findings and a positive histoplasminskin test or residence in an endemic region for Histoplasma capsulatum. There is no active systemic disease during diagnosis of POHS.Disciform scarring and macular CNV secondary to POHS is a well-known complication which leads to loss of visual acuity or visualdisturbance. Without therapy, the visual prognosis in these patients is unfavorable. Submacular surgery, radiation, steroids, photodynamictherapy, and most recently anti-vascular endothelial growth factor therapy are current therapeutic options for this condition. We report acase with persistent CNV secondary to POHS in a middle-aged woman with moderate myopia and the clinical course of treatment withmultiple intravitreal ranibizumab (Lucentis®, Novartis) injections.