Surgical removal of extensive peripapillary choroidal neovascularization associated with presumed ocular histoplasmosis syndrome.
OBJECTIVE
This study aimed to report the visual outcome of surgical removal of extensive peripapillary choroidal neovascularization (CNV) due to presumed ocular histoplasmosis syndrome (POHS).


METHODS
Retrospective review of the records of all patients seen at the Barnes Retina Institute who underwent surgical removal of extensive peripapillary CNV associated with POHS and who had at least 12 months of follow-up.


METHODS
Seventeen consecutive eyes (in 14 patients) undergoing surgical removal of extensive peripapillary CNV associated with POHS were studied.


METHODS
Pars plana vitrectomy and surgical removal of CNV were performed.


METHODS
Best-corrected Snellen visual acuity, funduscopic examination, and intravenous fluorescein angiography were obtained before surgery and at regular intervals after surgery.


RESULTS
In 14 of 17 eyes, the peripapillary CNV was subfoveal, and in 3 eyes, it was extrafoveal. All three eyes with extrafoveal CNV were not eligible for laser treatment according to Macular Photocoagulation Study guidelines because treatment would have spared less than 1.5 contiguous clock-hours of retina temporal to the optic disc. Follow-up ranged from 17 to 57 months, with a median of 32 months. In eyes with subfoveal CNV, best-corrected preoperative Snellen visual acuity ranged from 20/25 to counting fingers at 2 feet with a median of 20/200, and best-corrected final Snellen visual acuity ranged from 20/25 to 20/200 with a median of 20/40. In 7 (50%) of 14 eyes, a final Snellen acuity of 20/40 or better was achieved, and in all cases except 1, visual acuity improved or did not change with surgery. In the three eyes with extrafoveal CNV, best-corrected preoperative Snellen visual acuity ranged from 20/20 to 20/400 with a median of 20/200, and best-corrected final Snellen visual acuity was 20/20 in all cases. In addition, visual acuity improved with surgery.


CONCLUSIONS
The data from this small retrospective study suggest that surgical removal may provide visual benefit in selected cases of extensive peripapillary CNV due to POHS.
Atebara
N H
NH
Retina Associates of Hawaii, Honolulu, USA.
Thomas
M A
MA
Holekamp
N M
NM
Mandell
B A
BA
Del Priore
L V
LV
D000293:Adolescent; D000328:Adult; D002829:Choroid / Q000098:blood supply* / Q000503:physiopathology; D015821:Eye Infections, Fungal / Q000150:complications*; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006660:Histoplasmosis / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D009898:Optic Disk; D012189:Retrospective Studies; D013577:Syndrome; D016896:Treatment Outcome; D014792:Visual Acuity; D014794:Visual Fields; D014821:Vitrectomy