Focal macular choroidopathy

Risk factors for choroidal neovascularization in young patients: a case-control study

A pair-matched, case-control design was used to study exposure to Histoplasma capsulatum and other environmental factors, and to determine various host characteristics including human leukocyte antigen (HLA) typings in 94 young patients with macular choroidal neovascularization (CNV) and in 94 controls with other eye diseases. Patients with two types of retinal patterns were studied: Type I, or those with CNV with one or no chorioretinal atrophic spots in the posterior pole or periphery (n = 51), and Type II, or those with CNV and 2 or more chorioretinal atrophic spots (n = 43). Our purpose was to explore whether these two variants of idiopathic CNV have different and distinguishable epidemiologies which may or may not be related to prior exposure to Histoplasma. We found that histoplasmin skin tests were negative in all but two Type I cases. The combination of the HLA-B7 and HLA-DR2 markers (but not either marker alone) was significantly increased in Type I cases. Among Type II cases, HLA-B7, HLA-DR2, HLA-DQ1, a positive histoplasmin skin test, myopic refractive error, prior residence in a histoplasmosis endemic area, occupations involving exposure to animals, and hypertension were all significantly increased. Histoplasmin skin test responses were positive in 18 Type II cases (45%). In the multivariate analysis, only DR2 and the combined presence of DQ1 and a positive histoplasmin skin test remained predictive of Type II disease. Our findings suggest that histoplasmin sensitivity is associated with some, but not all, cases of Type II disease. However, histoplasmin sensitivity appears to have no relationship to Type I disease. HLA factors may play a role in both disease types, possibly by producing a modified immune response to Histoplasma and/or other unidentified agents.

Focal macular choroidopathy

The clinical and angiographic findings in 2 patients with focal macular choroidopathy (FMC) are described. Follow-up fluorescein angiography revealed that the initial lesions consisted of multifocal, whitish spot-like areas of choroidal infiltration with hyperfluorescence in the late phase angiogram. At a later stage of the disease, the developing disciform macular lesion showed subretinal neovascularization. The disease was bilateral with poor visual prognosis. There was no evidence of infection with Histoplasma capsulatum. Early oral corticosteroid treatment could not prevent the progressive nature of the disease.

A case of macular subretinal neovascularisation in chronic uveitis probably caused by sarcoidosis

A 29-year-old-man with a 7-year history of bilateral chronic uveitis developed subretinal neovascularisation in the macular area of his right eye. There was a history suggesting sarcoidosis. Long-term therapy with systemic corticosteroids decreased the activity of the uveitis, and the subretinal neovascularisation changed into a cystic scar. After the systemic corticosteroids were discontinued there was a recurrence of the uveitis but not of the subretinal neovascularisation.

Treatment of macular subretinal neovascularization with the red-light krypton laser in presumed ocular histoplasmosis syndrome

A patient with presumed ocular histoplasmosis and decreased visual acuity in one eye had subretinal neovascularization and retinal hemorrhage in the macular area. Argon-laser treatment to eradicate the subretinal neovascular membrane was contraindicated because of the proximity of the hemorrhagic lesion to the fovea. We used a red-light krypton laser (647 nm) because the light is not absorbed by the hemoglobin in the retinal hemorrhage or by the macular luteal pigment (xanthophyll), and because it is transmitted into the choroid, allowing treatment within the macular zone with less damage to the internal retinal elements. After treatment, the subretinal neovascular membrane completely disappeared and the macular hemorrhage cleared. To the best of our knowledge, this is the first time that a histoplasmic macular subretinal neovascular membrane has been treated with the red-light krypton laser.