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Henry J. Kaplan - One of the best experts on this subject based on the ideXlab platform.
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Submacular surgery for subfoveal choroidal neovascular membranes in patients with presumed Ocular Histoplasmosis.
Archives of ophthalmology (Chicago Ill. : 1960), 1997Co-Authors: Adam S. Berger, Lucian V. Del Priore, Mandi D. Conway, Rebecca S. Walker, John S. Pollack, Henry J. KaplanAbstract:Objective: To determine the visual results, recurrence rates, and postoperative complications of surgical removal of subfoveal choroidal neovascularization (CNV) in patients with the presumed Ocular Histoplasmosis syndrome. Design: A consecutive surgical series of 63 eyes of 62 patients with subfoveal CNV and the presumed Ocular Histoplasmosis syndrome with longer than 6 months of follow-up. Setting: Tertiary care university medical center. Methods: Patients underwent surgical removal of subfoveal CNV using vitreoretinal surgical techniques. The anatomical and functional results of surgery were analyzed. Results: The median age of the patients was 42 years (range, 16-68 years), and the median follow-up time was 24 months (range, 6-48 months). Visual acuity improved by 2 or more Snellen lines in 22 (35%) of the 63 eyes, was unchanged in 28 (44%) of the eyes, and worsened in 13 (21%) of the eyes. Eleven (17%) of the 63 eyes improved to a visual acuity of 20/50 or better. Eyes with an initial visual acuity of 20/200 or worse had a better prognosis for improved vision (ie, 26 [41%] of the eyes) than those with an initial visual acuity of 20/100 or better (ie, 5 [8%] of the eyes). Recurrence of the subfoveal CNV occurred in 24 (38%) of the 63 eyes and was more common in those eyes that received preoperative laser photocoagulation (ie, 15 [47%] of the eyes). The median time to recurrence was 5 months after surgery. Postoperative complications included macular striae in 4 (6%) of the 63 eyes, rhegmatogenous retinal detachment in 2 (3%) of the eyes, retinal tear in 1 (1.6%) of the eyes, and progression of cataract in 19 (30%) of the eyes. Conclusions: Surgical excision of subfoveal CNV may be an effective therapeutic modality in patients with the presumed Ocular Histoplasmosis syndrome that offers the possibility of improving central vision in many patients. Factors possibly associated with a favorable visual prognosis include younger patient age and the absence of previous laser photocoagulation.
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Perfusion of the Subfoveal Choriocapillaris Affects Visual Recovery After Submacular Surgery in Presumed Ocular Histoplasmosis Syndrome
American journal of ophthalmology, 1997Co-Authors: Levent Akduman, Vinay N. Desai, Lucian V. Del Priore, R. Joseph Olk, Henry J. KaplanAbstract:Purpose To determine the relationship between the visual result and perfusion of the subfoveal choriocapillaris after surgical excision of subfoveal neovascularization in presumed Ocular Histoplasmosis syndrome. Methods We reviewed the records of 38 eyes of 37 patients with gradable postoperative fluorescein angiograms and color photographs after surgical excision of a subfoveal neovascular membrane in presumed Ocular Histoplasmosis syndrome. The postoperative photographs and fluorescein angiograms were graded in a masked fashion for the presence of perfusion of the subfoveal choriocapillaris. We used preoperative and postoperative best-corrected visual acuities to determine the correlation between postoperative perfusion of the subfoveal choriocapillaris and both final visual acuity and visual improvement after surgery. Results After surgery, the subfoveal choriocapillaris was perfused in 24 of the 38 eyes (63%) and nonperfused in 14 (37%). Best-corrected visual acuity improved by at least 2 Snellen lines in 17 of the 24 perfused eyes (71%) and two of the 14 nonperfused eyes (14%) ( P = .0089). Best-corrected visual acuity of 20/100 or better was achieved in 18 of the perfused eyes (75%) and four nonperfused eyes (29%) ( P = .0076). Conclusion Both final visual acuity and improvement in visual acuity were correlated with postoperative perfusion of the subfoveal choriocapillaris in patients with presumed Ocular Histoplasmosis syndrome. Development of techniques to maintain or reestablish perfusion of the subfoveal choriocapillaris after surgery may improve visual outcome in these eyes.
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Presumed Ocular Histoplasmosis syndrome in the Netherlands
The British journal of ophthalmology, 1997Co-Authors: Gerald J Roper, Henry J. KaplanAbstract:The presumed Ocular Histoplasmosis syndrome (POHS) occurs in areas of the USA in which Histoplasma capsulatum is endemic. The Ocular triad of POHS consists of peripheral punched out chorioretinal scars, peripapillary atrophy, and maculopathy. The maculopathy most frequently consists of a subretinal neovascular complex associated with a previous focal chorioretinal scar. Vitritis is not observed in POHS. The characteristic Ocular presentation was associated with infection with H capsulatum through epidemiological studies.12 However, only rarely has the H capsulatum antigen and organism been identified in an eye with POHS. Khalil enucleated an eye with choroidal melanoma and demonstrated chorioretinal foci with various stages of chronic inflammation in which both the antigen …
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Choriocapillaris atrophy after submacular surgery in presumed Ocular Histoplasmosis syndrome.
Archives of ophthalmology (Chicago Ill. : 1960), 1995Co-Authors: Vinay N. Desai, Lucian V. Del Priore, Henry J. KaplanAbstract:We report herein a case of choroicapillaris atrophy that developed after surgical excision of a subfoveal neovascular membrane (SFNVM) in a patient with presumed Ocular Histoplasmosis syndrome. Report of a Case. A 42-year-old man presented with a 3-month history of decreased vision in the right eye. His visual acuity was 20/400 OD and 20/20 OS. A fundus examination revealed peripheral spots consistent with presumed Ocular Histoplasmosis syndrome in the left eye and an SFNVM in the right eye. Twenty-four hours later, the patient underwent surgical excision of the SFNVM using a previously described technique. 1 Two weeks postoperatively, fluorescein angiography revealed filling of the choriocapillaris in the area of the excised SFNVM, with surrounding blocked fluorescence ( Figure 1 , arrowhead 1). Atrophy of the choriocapillaris was present in the area under the retinotomy site (Figure 1, arrowhead 2). Two months postoperatively, the patient's vision had improved to 20/40. Fluorescein angiography
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Surgical removal of subfoveal neovascularization in the presumed Ocular Histoplasmosis syndrome.
American journal of ophthalmology, 1991Co-Authors: Matthew A. Thomas, Henry J. KaplanAbstract:We treated two patients with presumed Ocular Histoplasmosis, subfoveal neovascular membranes, and progressive visual acuity loss to 20/400. Vitreoretinal surgical techniques were used to remove the subfoveal membranes. Visual acuity returned to 20/20 with seven months of follow-up in one patient (Case 1) and to 20/40 with three months of follow-up in the other patient (Case 2). No evidence of persistent or recurrent subretinal neovascular membranes in either patient have been noted. These preliminary results suggest that vitreoretinal surgical techniques may be successful in mechanically removing subfoveal neovascular membranes with preservation of overlying neurosensory retina and thus preservation of central visual acuity.
Matthew A. Thomas - One of the best experts on this subject based on the ideXlab platform.
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Intravitreal Bevacizumab for Choroidal Neovascularization in Ocular Histoplasmosis
American journal of ophthalmology, 2008Co-Authors: Ramin Schadlu, Kevin J. Blinder, Gaurav K. Shah, M.g. Grand, Nancy M. Holekamp, Daniel P. Joseph, Matthew A. Thomas, Nicholas E. Engelbrecht, Rajendra S. Apte, Anita G. PrasadAbstract:Purpose To define the role of intravitreal bevacizumab in individuals with choroidal neovascularization (CNV) resulting from Ocular Histoplasmosis syndrome (OHS). Design Retrospective chart review of a surgical therapy. Methods We reviewed the course of 28 eyes of 28 patients who underwent intravitreal injection of bevacizumab for treatment of CNV secondary to OHS. Outcome was measured by pretreatment and posttreatment visual acuity (VA). Results The average pretreatment logarithm of the minimum angle of resolution (logMAR) VA was 0.65 (Snellen equivalent of 20/88). Mean follow-up was 22.43 weeks with an average of 1.8 intravitreal injections. Average final logMAR VA was 0.43 (Snellen equivalent of 20/54). Twenty eyes (71%) experienced an increase in central VA, whereas four eyes (14%) were unchanged and four eyes (14%) experienced a decrease in vision. Conclusions Intravitreal bevacizumab may improve or stabilize VA in a significant majority of patients with neovascular complications of OHS (24 eyes [85.7%] in our study population).
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Photodynamic therapy for juxtafoveal choroidal neovascularization due to Ocular Histoplasmosis syndrome.
Retina (Philadelphia Pa.), 2005Co-Authors: Gaurav K. Shah, Kevin J. Blinder, Matthew A. Thomas, Seenu M. Hariprasad, Edwin H. Ryan, Jeffrey A. Bakal, Sanjay SharmaAbstract:Purpose: To report the use of photodynamic therapy with verteporfin in patients with juxtafoveal choroidal neovascularization (CNV) for Ocular Histoplasmosis syndrome (OHS). Methods: Retrospective review. Data regarding the following variables were extracted from patient charts: demographic characteristics, previous surgeries, angiographic features, number and time of treatments, follow-up time, and change in visual acuity. Results: This study sample consisted of 23 eyes of 23 consecutive patients who were treated with photodynamic therapy for the management of juxtafoveal CNV. When post-treatment visual acuity (mean logMAR acuity = 0.321) was compared to baseline acuity (mean logMAR visual acuity = 3.89) vision improved by more than three Snellen lines in 30% of eyes, remained the same (±2 Snellen lines) in 52% of eyes, and worsened (greater than a two-line loss in visual acuity) in 18% of eyes. Although this series was uncontrolled, the patients had a trend toward a therapeutic benefit when compared to published natural history of similar cases (OR = 0.292, P value = 0.071 when compared to data from the Macular Photocoagulation Study for treatment of juxtafoveal lesions). Conclusion: Photodynamic therapy with verteporfin may be beneficial in patients with juxtafoveal CNV secondary to OHS in terms of both visual stabilization and improvement.
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Surgical Removal of Subfoveal Choroidal Neovascularization in Presumed Ocular Histoplasmosis: Stability of Early Visual Results
Ophthalmology, 1997Co-Authors: Nancy M. Holekamp, Matthew A. Thomas, John D. Dickinson, Shailaja ValluriAbstract:Purpose: The authors assess the stability of visual acuity outcomes after the surgical removal of subfoveal choroidal neovascularization in a large series of patients with presumed Ocular Histoplasmosis syndrome (PONS). Methods: A retrospective study of 117 consecutive patients undergoing vitrectomy between February 1990 and December 1994 was performed. All patients underwent the surgical removal of subfoveal choroidal neovascularization due to POHS and had at least 3 months of follow-up. Postoperative Snellen visual acuity was the primary study endpoint. Results: With a median follow-up of 13 months (range, 3–46 months), 35% of patients had postoperative visual acuity of 20140 or better, and 40% had improvement of three or more Snellen lines after surgery. In a subset of 54 eyes followed for at least 1 year, 91% showed stable or improved vision between the 3- and 12-month time points, and 85% showed stable or improved vision between 3 months and final visit. Conclusion: Follow-up of a large number of patients appears to confirm initially encouraging results and to suggest stability of beneficial effect after the surgical removal of subfoveal choroidal neovascularization in POHS.
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Managing Recurrent Neovascularization after Subfoveal Surgery in Presumed Ocular Histoplasmosis Syndrome
Ophthalmology, 1996Co-Authors: Nancy S. Melberg, Matthew A. Thomas, John D. Dickinson, Shailaja ValluriAbstract:Purpose: To report the authors' experience with recurrent neovascularization after subfoveal surgery in the presumed Ocular Histoplasmosis syndrome (POHS). Methods: One-hundred seventeen patients with POHS and subfoveal choroidal neovascularization were followed a median of 13 months after submacular surgery. Results: Recurrent neovascularization developed in 51 eyes (44%). The median time to recurrence was 3 months (range, 0.5-28 months). Recurrence location was extrafoveal in 16%, juxtafoveal in 18%,and subfoveal in 66%. Sixteen eyes were treated with laser photocoagulation, 17 eyes underwent repeat submacular surgery, and 18 eyes were observed. The visual outcome for patients with recurrences amenable to laser was better than that for patients who were observed or who underwent surgery. Conclusion: Recurrent neovascularization after surgery is common; prompt recognition may allow laser photocoagulation.
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Surgical removal of subfoveal neovascularization in the presumed Ocular Histoplasmosis syndrome.
American journal of ophthalmology, 1991Co-Authors: Matthew A. Thomas, Henry J. KaplanAbstract:We treated two patients with presumed Ocular Histoplasmosis, subfoveal neovascular membranes, and progressive visual acuity loss to 20/400. Vitreoretinal surgical techniques were used to remove the subfoveal membranes. Visual acuity returned to 20/20 with seven months of follow-up in one patient (Case 1) and to 20/40 with three months of follow-up in the other patient (Case 2). No evidence of persistent or recurrent subretinal neovascular membranes in either patient have been noted. These preliminary results suggest that vitreoretinal surgical techniques may be successful in mechanically removing subfoveal neovascular membranes with preservation of overlying neurosensory retina and thus preservation of central visual acuity.
Brendan R. Jackson - One of the best experts on this subject based on the ideXlab platform.
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Presumed Ocular Histoplasmosis syndrome in a commercially insured population, United States
PloS one, 2020Co-Authors: Kaitlin Benedict, Jessica G. Shantha, Steven Yeh, Karlyn D. Beer, Brendan R. JacksonAbstract:Purpose To describe epidemiologic features of patients with presumed Ocular Histoplasmosis syndrome (POHS) in the United States using insurance claims data and compare POHS patients with and without choroidal neovascularization (CNV). Design Retrospective cohort study. Methods Patients with International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for Histoplasmosis retinitis on an outpatient claim in the 2014 IBM® MarketScan® Commercial Database and the Medicare Supplemental Database who were enrolled for at least 2 years after the POHS code. Main outcome measures Data related to testing, treatment, and direct medical costs. Results Among >50 million total MarketScan enrollees, 6,678 (13 per 100,000) had a POHS diagnosis code. Of those, 2,718 were enrolled for 2 years; 698 (25%) of whom had a CNV code. Eleven of the 13 states with the highest POHS rates bordered the Mississippi and Ohio rivers. CNV patients had significantly more eye care provider visits (mean 8.8 vs. 3.2, p
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presumed Ocular Histoplasmosis syndrome in a commercially insured population united states
PLOS ONE, 2020Co-Authors: Kaitlin Benedict, Jessica G. Shantha, Steven Yeh, Karlyn D. Beer, Brendan R. JacksonAbstract:Purpose To describe epidemiologic features of patients with presumed Ocular Histoplasmosis syndrome (POHS) in the United States using insurance claims data and compare POHS patients with and without choroidal neovascularization (CNV). Design Retrospective cohort study. Methods Patients with International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for Histoplasmosis retinitis on an outpatient claim in the 2014 IBM® MarketScan® Commercial Database and the Medicare Supplemental Database who were enrolled for at least 2 years after the POHS code. Main outcome measures Data related to testing, treatment, and direct medical costs. Results Among >50 million total MarketScan enrollees, 6,678 (13 per 100,000) had a POHS diagnosis code. Of those, 2,718 were enrolled for 2 years; 698 (25%) of whom had a CNV code. Eleven of the 13 states with the highest POHS rates bordered the Mississippi and Ohio rivers. CNV patients had significantly more eye care provider visits (mean 8.8 vs. 3.2, p<0.0001), more ophthalmic imaging tests, higher rates of treatment with anti-vascular endothelial growth factor injections (45% vs. 4%, p<0.0001), and incurred higher mean total yearly costs ($1,251.83 vs. $251.36, p<0.0001) than POHS patients without CNV. Conclusions Although the relationship between Histoplasma and POHS remains controversial, geographic patterns of POHS patient residence were consistent with the traditionally reported range of the fungus. CNV in the context of POHS was associated with additional healthcare use and costs. Further research to understand POHS etiology, risk factors, prevalence, and complications is needed, along with early diagnosis and treatment strategies.
Shailaja Valluri - One of the best experts on this subject based on the ideXlab platform.
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Surgical Removal of Subfoveal Choroidal Neovascularization in Presumed Ocular Histoplasmosis: Stability of Early Visual Results
Ophthalmology, 1997Co-Authors: Nancy M. Holekamp, Matthew A. Thomas, John D. Dickinson, Shailaja ValluriAbstract:Purpose: The authors assess the stability of visual acuity outcomes after the surgical removal of subfoveal choroidal neovascularization in a large series of patients with presumed Ocular Histoplasmosis syndrome (PONS). Methods: A retrospective study of 117 consecutive patients undergoing vitrectomy between February 1990 and December 1994 was performed. All patients underwent the surgical removal of subfoveal choroidal neovascularization due to POHS and had at least 3 months of follow-up. Postoperative Snellen visual acuity was the primary study endpoint. Results: With a median follow-up of 13 months (range, 3–46 months), 35% of patients had postoperative visual acuity of 20140 or better, and 40% had improvement of three or more Snellen lines after surgery. In a subset of 54 eyes followed for at least 1 year, 91% showed stable or improved vision between the 3- and 12-month time points, and 85% showed stable or improved vision between 3 months and final visit. Conclusion: Follow-up of a large number of patients appears to confirm initially encouraging results and to suggest stability of beneficial effect after the surgical removal of subfoveal choroidal neovascularization in POHS.
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Managing Recurrent Neovascularization after Subfoveal Surgery in Presumed Ocular Histoplasmosis Syndrome
Ophthalmology, 1996Co-Authors: Nancy S. Melberg, Matthew A. Thomas, John D. Dickinson, Shailaja ValluriAbstract:Purpose: To report the authors' experience with recurrent neovascularization after subfoveal surgery in the presumed Ocular Histoplasmosis syndrome (POHS). Methods: One-hundred seventeen patients with POHS and subfoveal choroidal neovascularization were followed a median of 13 months after submacular surgery. Results: Recurrent neovascularization developed in 51 eyes (44%). The median time to recurrence was 3 months (range, 0.5-28 months). Recurrence location was extrafoveal in 16%, juxtafoveal in 18%,and subfoveal in 66%. Sixteen eyes were treated with laser photocoagulation, 17 eyes underwent repeat submacular surgery, and 18 eyes were observed. The visual outcome for patients with recurrences amenable to laser was better than that for patients who were observed or who underwent surgery. Conclusion: Recurrent neovascularization after surgery is common; prompt recognition may allow laser photocoagulation.
Kaitlin Benedict - One of the best experts on this subject based on the ideXlab platform.
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Presumed Ocular Histoplasmosis syndrome in a commercially insured population, United States
PloS one, 2020Co-Authors: Kaitlin Benedict, Jessica G. Shantha, Steven Yeh, Karlyn D. Beer, Brendan R. JacksonAbstract:Purpose To describe epidemiologic features of patients with presumed Ocular Histoplasmosis syndrome (POHS) in the United States using insurance claims data and compare POHS patients with and without choroidal neovascularization (CNV). Design Retrospective cohort study. Methods Patients with International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for Histoplasmosis retinitis on an outpatient claim in the 2014 IBM® MarketScan® Commercial Database and the Medicare Supplemental Database who were enrolled for at least 2 years after the POHS code. Main outcome measures Data related to testing, treatment, and direct medical costs. Results Among >50 million total MarketScan enrollees, 6,678 (13 per 100,000) had a POHS diagnosis code. Of those, 2,718 were enrolled for 2 years; 698 (25%) of whom had a CNV code. Eleven of the 13 states with the highest POHS rates bordered the Mississippi and Ohio rivers. CNV patients had significantly more eye care provider visits (mean 8.8 vs. 3.2, p
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presumed Ocular Histoplasmosis syndrome in a commercially insured population united states
PLOS ONE, 2020Co-Authors: Kaitlin Benedict, Jessica G. Shantha, Steven Yeh, Karlyn D. Beer, Brendan R. JacksonAbstract:Purpose To describe epidemiologic features of patients with presumed Ocular Histoplasmosis syndrome (POHS) in the United States using insurance claims data and compare POHS patients with and without choroidal neovascularization (CNV). Design Retrospective cohort study. Methods Patients with International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for Histoplasmosis retinitis on an outpatient claim in the 2014 IBM® MarketScan® Commercial Database and the Medicare Supplemental Database who were enrolled for at least 2 years after the POHS code. Main outcome measures Data related to testing, treatment, and direct medical costs. Results Among >50 million total MarketScan enrollees, 6,678 (13 per 100,000) had a POHS diagnosis code. Of those, 2,718 were enrolled for 2 years; 698 (25%) of whom had a CNV code. Eleven of the 13 states with the highest POHS rates bordered the Mississippi and Ohio rivers. CNV patients had significantly more eye care provider visits (mean 8.8 vs. 3.2, p<0.0001), more ophthalmic imaging tests, higher rates of treatment with anti-vascular endothelial growth factor injections (45% vs. 4%, p<0.0001), and incurred higher mean total yearly costs ($1,251.83 vs. $251.36, p<0.0001) than POHS patients without CNV. Conclusions Although the relationship between Histoplasma and POHS remains controversial, geographic patterns of POHS patient residence were consistent with the traditionally reported range of the fungus. CNV in the context of POHS was associated with additional healthcare use and costs. Further research to understand POHS etiology, risk factors, prevalence, and complications is needed, along with early diagnosis and treatment strategies.
