Preventing reactivation of ocular histoplasmosis: guidance for patients at risk.
BACKGROUND
Ocular histoplasmosis syndrome (OHS), a significant cause of vision loss in young and middle-aged adults, is associated with the fungus Histoplasma capsulatum (Hc). There is considerable evidence that recurrent reactivation of perimacular ocular histoplasmosis lesions is an important cause of disease progression and that vision loss is at least, in part, a consequence of host sensitivity to fungal antigen.


METHODS
The etiology and pathogenesis of OHS is reviewed and specific recommendations are made for patients with OHS that may decrease the risk of reactivation of ocular histoplasmosis lesions and slow disease progression.


CONCLUSIONS
Patients with perimacular chorioretinal scars secondary to OHS should be informed by the clinician that they are at risk for vision loss; they should be told the symptoms of choroidal neovascularization and how to self-monitor their vision with an Amsler grid. We recommend they also be instructed on how to decrease their risk of reinfection by Hc. Aggressive treatment of dermatomycoses, onychomycosis, vaginal candidiasis, and other chronic fungal infections may decrease the risk of reactivation of ocular lesions. Patients with OHS who are considering LASIK surgery should be informed that the procedure may trigger choroidal neovascularization.
Trevino
Richard
R
Evansville Outpatient Clinic, Department of Veteran's Affairs, Evansville, Indiana 47713-2438, USA. rtrevino1@yahoo.com
Salvat
Ricardo
R
D000818:Animals; D000935:Antifungal Agents / Q000627:therapeutic use*; D015821:Eye Infections, Fungal / Q000473:pathology / Q000517:prevention & control*; D006660:Histoplasmosis / Q000473:pathology / Q000517:prevention & control*; D006801:Humans; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D055502:Secondary Prevention
D000935:Antifungal Agents