Proton-beam irradiation of subfoveal choroidal neovascular membranes in presumed ocular histoplasmosis syndrome: a case report.
BACKGROUND
Presumed ocular histoplasmosis syndrome (POHS) refers to a choroidopathy that is characterized by the presence of multiple peripheral atrophic chorioretinal scars, peri-papillary atrophy, and choroidal neovascular membranes (CNVM), usually in or adjacent to the fovea. In the United States, POHS is an important cause of loss of central visual acuity in patients between the ages of 20 and 50 years. A number of treatment options for subfoveal and juxtafoveal CNVMs in POHS have been under investigation, including laser photocoagulation, surgical excision of the CNVM, and radiation therapy.


METHODS
A 28-year-old women was referred to our office reporting decreased depth perception and finger-counting vision in the right eye for the duration of 1 month. A diagnosis of POHS with subfoveal CNVM was made and the patient was referred for an experimental protocol of proton-beam irradiation. Four months after her initial visit, the patient returned, reporting blurry vision with a blind spot in her left eye. A subfoveal CNVM in the left eye was subsequently treated with irradiation as well. Seven months after the initial treatment, visual acuities were 20/20 in each treated eye.


CONCLUSIONS
Although is currently an experimental procedure, proton-beam irradiation appears to be a promising treatment for subfoveal CNVM in patients with POHS.
Liem
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Kittery Ophthalmic Consultants, Maine, USA.
Armbruster
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D000328:Adult; D002829:Choroid / Q000098:blood supply*; D015821:Eye Infections, Fungal / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005584:Fovea Centralis / Q000473:pathology; D005654:Fundus Oculi; D006660:Histoplasmosis / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D009389:Neovascularization, Pathologic / Q000175:diagnosis / Q000382:microbiology / Q000532:radiotherapy*; D011522:Protons; D013577:Syndrome
D011522:Protons