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Abstract
In summary, there are various factors which play an important prognostic role in the final visual acuity of patients with active histoplasma maculopathy. The factors over which we have no control is the location of the neovascular membrane in this maculopathy. The factors over which we do have control are how and when to treat it. We feel that laser photocoagulation is an effective method of treatment. It has been possible to obliterate the NVM as close as 200 micrometers from the foveola, thus preventing the development of subfoveal NVMs which have such a poor visual prognosis. The most important factor is the early treatment with laser photocoagulation. If we could treat all patients within 4 weeks of initial visual symptoms (group A), we might be able to eliminate a large number of patients (group C) who have a much poorer visual prognosis. Serial postoperative fluorescein studies are necessary to detect recurrent neovascular membranes which require further treatment.
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Kara HV, Javidfar J, Hirji SA, Balderson SS, D'Amico TA. Thoracoscopic pneumonectomy in management of histoplasmosis and fibrosing mediastinitis. Ann Thorac Surg 2014; 98:e95-6. [PMID: 25282249 DOI: 10.1016/j.athoracsur.2014.06.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 05/27/2014] [Accepted: 06/24/2014] [Indexed: 11/18/2022]
Abstract
Pulmonary histoplasmosis is generally a self-limited respiratory illness in endemic areas. Fibrosing mediastinitis is a severe chronic complication of pulmonary histoplasmosis in which pulmonary vessels and airways can be compressed with the potential for life-threatening implications. We present a 50-year-old male patient who presented with a total occlusion of the left pulmonary artery due to fibrosing mediastinitis.
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Affiliation(s)
- H Volkan Kara
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina.
| | - Jeffrey Javidfar
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Sameer A Hirji
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Stafford S Balderson
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thomas A D'Amico
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
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Han P, Yan W, Luo Y, Tu W, He JY, Liu JM, Gong J, Wang YW, Li MK, Tian DA, Huang HJ. Chronic bronchitis with fungal infection presenting with marked elevation of serum carbohydrate antigen 19-9: a case report. Int J Clin Exp Pathol 2014; 7:6307-6312. [PMID: 25337284 PMCID: PMC4203255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 08/20/2014] [Indexed: 06/04/2023]
Abstract
Carbohydrate antigen 19-9 (CA19-9) is the most frequently applied serum tumor marker for diagnosis of cancers in the digestive organs. However, some patients with benign diseases can have elevated serum levels of CA19-9 as well. The current study presents a 55-year-old female who was admitted to our hospital for further evaluation of a nodular cavity shadow in the right lower lobe and clarification of the cause of the marked elevation of serum CA19-9 levels. Abdominal MRI and gastrointestinal endoscopy did not find any malignancy. As lung cancer cannot be excluded in this patient, a video-assisted thoracoscopic surgery was carried, intraoperative and postoperative biopsy analysis both suggested chronic bronchitis with fungal infection (due to Histoplasma capsulatum or Penicillium marneffei) and organization. Immunohistochemistry showed marked positive staining for CA19-9 in the damaged lung tissue. The CA19-9 levels quickly returned to the normal range following lobe resection. Therefore, the marked elevation of serum CA19-9 levels, in this case, may have resulted from the chronic bronchitis with fungal infection.
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MESH Headings
- Biomarkers/blood
- Biopsy
- Bronchitis, Chronic/blood
- Bronchitis, Chronic/diagnosis
- Bronchitis, Chronic/microbiology
- Bronchitis, Chronic/surgery
- CA-19-9 Antigen/blood
- Female
- Histoplasma/pathogenicity
- Histoplasmosis/blood
- Histoplasmosis/diagnosis
- Histoplasmosis/microbiology
- Histoplasmosis/surgery
- Humans
- Immunohistochemistry
- Lung Diseases, Fungal/blood
- Lung Diseases, Fungal/diagnosis
- Lung Diseases, Fungal/microbiology
- Lung Diseases, Fungal/surgery
- Middle Aged
- Penicillium/pathogenicity
- Pneumonectomy/methods
- Predictive Value of Tests
- Thoracic Surgery, Video-Assisted
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Up-Regulation
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Affiliation(s)
- Ping Han
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, China
| | - Wei Yan
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, China
| | - Yi Luo
- Tuberculosis Prevention Institution of Wuhan Wuhan 430030, China
| | - Wei Tu
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, China
| | - Jia-Yi He
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, China
| | - Jing-Mei Liu
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, China
| | - Jin Gong
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, China
| | - Yun-Wu Wang
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, China
| | - Meng-Ke Li
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, China
| | - De-An Tian
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, China
| | - Huan-Jun Huang
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan 430030, China
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Pai RR, Kangath RV, Thamban I. Histoplasmosis mimicking adrenal carcinoma. Conn Med 2014; 78:17-20. [PMID: 24600775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The incidence of unilateral adrenal histoplasmosis in nonendemic areas is rare. This is even rarer if the host is immunocompetent. METHODS We report a patient who was referred for unexplained weight loss who underwent a computed tomography scan of abdomen revealing a large unilateral adrenal nodule measuring 7.6 cm in size. RESULTS Hormonal workup was negative including urine 24-hour free metanephrines, and the patient underwent unilateral adrenalectomy. The pathology showed budding yeast that stained with Gomori's methenamine silver (GMS) revealed the diagnosis of adrenal histoplasmosis. CONCLUSION We encourage clinicians to include infection by Histoplasma capsulatum as well as other granulomatous diseases and tumors in the differential diagnosis of unilateral adrenal enlargement even in immunocompetent hosts living in nonendemic areas.
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Affiliation(s)
- Rajasreepai Ramachandra Pai
- Division of Endocrinology, Department of Internal Medicine, Baylor Scott & Whit e Health/Texas A&M Health Science Center College of Medicine, Temple, Texas, USA.
| | - Raghesh Varot Kangath
- Division of Infectious Diseases, Department of Internal Medicine, Baylor Scott & White Health/Texas A&M Health Science Center College of Medicine, Temple, Texas, USA
| | - Immanuel Thamban
- Division Endocrinology and Metabolism, Central Texas Veteran's Health Care System, Temple, Texas, USA
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Abstract
We describe the case of a 64-year-old woman with a solitary pulmonary nodule and a previous breast carcinoma whose diagnosis of histoplasmoma was established only after surgical resection and appropriate stains. It is important not to confuse these two diseases as this will prevent inappropriate medical treatment. Limited surgery is indicated for the treatment of these circumscribed lesions.
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Affiliation(s)
- D Galetta
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
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Manning TC, Born D, Tredway TL. Spinal intramedullary histoplasmosis as the initial presentation of human immunodeficiency virus infection: case report. Neurosurgery 2006; 59:E1146; discussion E1146. [PMID: 17143208 DOI: 10.1227/01.neu.0000245583.08532.35] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Spinal intramedullary histoplasmosis is an extremely rare condition. We report a case of isolated intramedullary histoplasmosis as the initial manifestation of human immunodeficiency virus (HIV) infection. CLINICAL PRESENTATION A 27-year-old man presented with a rapidly progressive paraparesis. Magnetic resonance imaging scans revealed an enhancing lesion at C7-T1 with edema extending as far as the cervicomedullary junction. He improved with steroid medications. INTERVENTION The patient underwent laminectomy and biopsy of the lesion. The diagnosis of histoplasmosis was made by histology, culture, and polymerase chain reaction identification of fungal deoxyribonucleic acid. The patient did not have disseminated histoplasmosis. Subsequent to the biopsy, the patient was discovered to have HIV infection. CONCLUSION The isolated spinal histoplasmosis lesion thus represented the initial presentation of HIV infection. Management of the case and diagnostic issues are discussed.
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Affiliation(s)
- Thomas C Manning
- Department of Neurological Surgery, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA.
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Affiliation(s)
- Ahmed Awab
- Department of Internal Medicine, Oklahoma University Health Sciences Center, Oklahoma City, Okla, USA
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Smith JS, Quiñones-Hinojosa A, Phillips JJ, Bollen AW, McDermott MW, Cha S. Limitations of diffusion-weighted imaging in distinguishing between a brain tumor and a central nervous system histoplasmoma. J Neurooncol 2006; 79:217-8. [PMID: 16850113 DOI: 10.1007/s11060-005-9007-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2005] [Accepted: 06/23/2005] [Indexed: 11/30/2022]
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Assi M, McKinsey DS, Driks MR, O'Connor MC, Bonacini M, Graham B, Manian F. Gastrointestinal histoplasmosis in the acquired immunodeficiency syndrome: report of 18 cases and literature review. Diagn Microbiol Infect Dis 2006; 55:195-201. [PMID: 16545932 DOI: 10.1016/j.diagmicrobio.2006.01.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Revised: 01/09/2006] [Accepted: 01/11/2006] [Indexed: 12/18/2022]
Abstract
No large case series of gastrointestinal histoplasmosis (GIH) in patients with AIDS has been published. We report 18 cases and review 34 published cases in the medical literature. We did a retrospective chart review from patients seen in our medical practices between 1989 and 2004. Most of our patients were men who had sex with men and who were not receiving highly active antiretroviral therapy. Median CD4 count was 34/muL. The most common presenting symptoms were diarrhea, fever, abdominal pain, and weight loss. The most commonly involved site was the colon or cecum. Biopsies revealed visible Histoplasma capsulatum organisms in 89%. Cultures from any site were positive in 76.9%. Four patients died from GIH. Gastrointestinal histoplasmosis occurs in severely immunocompromised patients with AIDS not receiving highly active antiretroviral therapy. Typical manifestations include diarrhea, fever, abdominal pain, and weight loss. Diagnosis is confirmed by blood or gastrointestinal tissue culture. Improvements in antiretroviral and antifungal therapies appear to have reduced the incidence of GIH and may improve the prognosis of this disease.
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10
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Abstract
BACKGROUND Histoplasma capsulatum is a dimorphic fungus with both hyphal and microconidial elements and is endemic in certain areas of the central United States. Most clinically recognized syndromes are self-limited, presenting in more than 80% of cases as an influenza-like acute pulmonary illness. We encountered four patients with an endobronchial presentation of histoplasmosis masquerading as a bronchogenic malignancy. METHODS The patient files from one of the authors (PR) uncovered four patients diagnosed with, and treated for, endobronchial histoplasmosis; all cases were referred for a presumptive diagnosis of endobronchial neoplasia. RESULTS The case study group comprised three women, ages 52, 68, and 81 years, respectively, and one man age 29 years, all presenting with recurrent hemoptysis. An obstructing adherent lesion was apparent on bronchoscopy in three, involving the right upper lobe bronchus in two, and right mainstem bronchus in one. In one patient, blood was observed in the bronchus intermedius; there was no gross lesion. Recurrent hemoptysis necessitated a right upper sleeve lobectomy in one, a right upper lobe lobectomy and right lower wedge resection in one, a right middle lobectomy in one, and wedge resection of the right upper lobe in one. CONCLUSIONS Endobronchial histoplasmosis may mimic primary bronchogenic carcinoma, presenting as a fixed obstructing endobronchial lesion associated with hemoptysis; the latter potentially necessitating surgical intervention. Endobronchial histoplasmosis should be considered in the differential diagnosis of obstructing endobronchial lesions associated with hemoptysis, especially when prior and(or) concurrent biopsies fail to disclose malignancy.
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Affiliation(s)
- Patrick Ross
- Department of Cardiothoracic Surgery, The Ohio State University, Columbus 43210, USA.
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Orr PR, Marsh MJ, Hawkins BS, Hawse PL, Bressler NM. Evaluation of the traveling vision examiner program in the submacular surgery trials pilot study. Ophthalmic Epidemiol 2005; 12:47-57. [PMID: 15848920 DOI: 10.1080/09286580490907814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To describe methods and results and to assess the value of a Traveling Vision Examiner (TVE) Program designed to provide masked vision measurements by expert vision examiners who were independent of, and traveled to, local clinical centers. METHODS The Submacular Surgery Trials (SST) Pilot Study was conducted to refine the design and methods for a set of multicenter, randomized clinical trials to evaluate submacular surgery in patients with subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD) or ocular histoplasmosis (OHS), or idiopathic CNV in which the primary study outcome would be change in 2-year best-corrected vision from baseline. As part of the SST Pilot Study, the feasibility and value of a TVE Program was assessed. The goal of the program was to obtain unbiased vision measurements, according to a standard protocol, of best-corrected visual acuity, reading speed, and contrast threshold, of each patient at 2 and 4 years after enrollment. RESULTS Eighty-three visits by TVEs were made to 16 centers participating in the SST Pilot Study; 239 patients had at least one masked vision examination. Comparison of pairs of vision measurements of the traveling vision examiners and local vision examiners for 71 patients made on the same day showed good agreement overall (intraclass correlation coefficient > or = 0.81). CONCLUSIONS The proposed TVE Program was judged to be a feasible and useful method of providing standardized, unbiased, masked vision measurements. This approach was incorporated into the larger clinical trials conducted by the SST Research Group.
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Affiliation(s)
- Peggy R Orr
- The Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21205-2010, USA.
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Solomon SD, Bressler SB, Hawkins BS, Marsh MJ, Bressler NM. GUIDELINES FOR INTERPRETING RETINAL PHOTOGRAPHS AND CODING FINDINGS IN THE SUBMACULAR SURGERY TRIALS (SST). Retina 2005; 25:253-68. [PMID: 15805900 PMCID: PMC1256025 DOI: 10.1097/00006982-200504000-00002] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the guidelines followed by the Submacular Surgery Trials (SST) Research Group in the interpretation of color fundus photographs and fluorescein angiograms of subfoveal choroidal neovascular lesions evaluated in the SST and to assist ophthalmologists in applying the results of the SST. METHODS Stereoscopic color fundus photographs and fluorescein angiograms of the study eye and nonstudy eye of 1,015 patients with subfoveal choroidal neovascular lesions secondary to age-related macular degeneration, ocular histoplasmosis syndrome, or idiopathic choroidal neovascularization (CNV) were obtained and graded by certified SST fundus photograph readers at the baseline examination in three randomized clinical trials comparing surgery with observation. Adherence to the inclusion and exclusion criteria and ocular features that might affect visual outcome were documented. Stereoscopic color fundus photography and fluorescein angiography were repeated 1 month after randomization for patients assigned to surgery to provide documentation that surgery was performed and to assess compliance with the surgery protocol. Photographs and fluorescein angiograms of both the study eye and the fellow eye in all patients then were obtained 3 months, 6 months, and 12 months after randomization and then annually up to 48 months. The kappa statistic was used to evaluate interobserver reliability of photograph gradings. RESULTS Lesion components at baseline included classic CNV, occult CNV, and features contiguous to CNV, including blood, fibrous tissue, hypofluorescence not corresponding to blood, serous detachment of the retinal pigment epithelium, and prior areas of laser photocoagulation. At follow-up, fluorescein leakage from CNV was assessed peripheral to or within the area of the retinal pigment epithelium abnormality after surgery. The lesion at follow-up could include any of the features identified at baseline as well as retinal pigment epithelium abnormalities, such as mottling of the retinal pigment epithelium with a subtle transition to normal retinal pigment epithelium or a very sharply demarcated, markedly hypopigmented area that was easily distinguished from the surrounding retinal pigment epithelium. kappa statistics for interobserver reliability ranged from good (0.47) to excellent (1.00) for features graded at baseline and follow-up. CONCLUSIONS Although some of the definitions essential to the interpretation of the SST are similar to those used in the Macular Photocoagulation Study and randomized clinical trials of photodynamic therapy with verteporfin, this guideline provides new information regarding lesion components at baseline as well as standardized descriptions of lesions after submacular surgery. These descriptions from the SST assist in understanding what lesions were studied, when additional treatment was considered after surgery, and how anatomical results should be interpreted.
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Affiliation(s)
- Sharon D Solomon
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21205-2005, USA.
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Sadda SR, Pieramici DJ, Marsh MJ, Bressler NM, Bressler SB. Changes in lesion size after submacular surgery for subfoveal choroidal neovascularization in the submacular surgery trials pilot study. Retina 2005; 24:888-99. [PMID: 15579986 DOI: 10.1097/00006982-200412000-00008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the size of subfoveal lesions based on photographic documentation before and after submacular surgery of choroidal neovascularization (CNV) lesions. METHODS Subfoveal lesion sizes at baseline and month 3 follow-up visits for patients assigned to surgery in the Submacular Surgery Trials (SST) Pilot Study were assessed categorically using Macular Photocoagulation Study (MPS) disc area (DA) circles. The Submacular Surgery Trials Pilot Study groups reviewed were as follows: Group N (age-related macular degeneration [AMD]; lesion <50% blood; classic CNV present; size < or =9 MPS DAs); Group R (AMD; prior nonfoveal laser; classic CNV present; size < or =9 MPS DAs); Group B (AMD; lesion > or =50% blood); and Group H (ocular histoplasmosis syndrome or idiopathic; classic CNV present; size < or =9 MPS DAs). RESULTS Postoperative month 3 lesion size was at least 1 size category smaller than the preoperative lesion size in 6% (4/66) of Group N, 0 (0/31) of Group R, 6% (2/34) of Group H, and 45% (18/40) of Group B eyes. In Group H eyes, there was no size change in 50% (17/34), and enlargement was found in 44% (15/34). For eyes in Groups N and R, approximately one third remained stable (20/66, 30% and 12/31, 39%, respectively), whereas two thirds enlarged by at least 1 category (42/66, 64% and 19/31, 61%, respectively). CONCLUSIONS The change in lesion size after submacular surgery was variable, with a tendency for Group H lesions to remain the same size or larger, Group B lesions to measure smaller, and Group N and Group R lesions to be larger.
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Affiliation(s)
- Srinivas R Sadda
- Doheny Retina Institute, Doheny Eye Institute, Los Angeles, California, USA
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Submacular Surgery Trials Research Group. Health- and vision-related quality of life among patients with ocular histoplasmosis or idiopathic choroidal neovascularization at enrollment in a randomized trial of submacular surgery: Submacular Surgery Trials Report No. 5. Arch Ophthalmol 2005; 123:78-88. [PMID: 15642816 DOI: 10.1001/archopht.123.1.78] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To (1) summarize vision-targeted and general health-related quality-of-life scores at baseline and quantify the effect of the ophthalmic problem, (2) evaluate the strength of relations between visual acuity and interview scores, and (3) compare scores for patients who also had choroidal neovascular lesions in the fellow eye (bilateral cases) with those of patients who had choroidal neovascularization in only the study eye (unilateral cases) at time of enrollment in a randomized trial of surgical removal of subfoveal choroidal neovascularization, either associated with the ocular histoplasmosis syndrome or of idiopathic origin. DESIGN Eligible patients had subfoveal choroidal neovascularization (including some classic choroidal neovascularization) and a visual acuity of 20/50 to 20/800 (Snellen equivalent), inclusive, in the eye to be assigned randomly to surgery or observation. Interviews that incorporated the 39-item version of the National Eye Institute Visual Function Questionnaire (NEI-VFQ) and 2 other instruments were conducted by telephone by trained interviewers before patients enrolled and were assigned randomly to surgery or observation. Information from baseline clinical examinations and fluorescein angiograms interpreted centrally by masked readers was used to classify patients as unilateral or bilateral cases and to provide potential explanations for variability of interview responses using linear regression models. RESULTS The median overall NEI-VFQ score was 75 (interquartile range, 60-84). The median scores on individual subscales ranged from 55 (general vision) to 100 (color vision). The visual acuity of the better-seeing eye accounted for much of the variability in scores on most NEI-VFQ subscales; a 3-line difference in visual acuity was associated with a 10-point or greater difference in scores on 5 subscales after adjustment for other characteristics of patients and eyes. Scores on most scales of all 3 instruments differed between unilateral cases (n = 167) and bilateral cases (n = 58). Even after adjustment for visual acuity and reading speed of the better-seeing eye, age, gender, and scores on the other instruments, scores on the NEI-VFQ near and distance activities subscales differed by almost 13 and 10 points, respectively, between unilateral and bilateral cases. Neither age nor gender was an important independent explanatory variable for NEI-VFQ scores. CONCLUSIONS Unilateral and bilateral cases had vision-targeted health-related quality-of-life scores worse than those published for a reference population without eye disease. Furthermore, despite younger age, better visual acuity, and better short-term visual prognosis, bilateral cases had NEI-VFQ scores at baseline similar to those published for 2 groups of patients with age-related macular degeneration. Unidentified factors, in addition to the visual acuity of the better-seeing eye, affected patients' perceptions of visual function.
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Hawkins BS, Miskala PH, Bass EB, Bressler NM, Childs AL, Mangione CM, Marsh MJ. Surgical removal vs observation for subfoveal choroidal neovascularization, either associated with the ocular histoplasmosis syndrome or idiopathic: II. Quality-of-life findings from a randomized clinical trial: SST Group H Trial: SST Report No. 10. ACTA ACUST UNITED AC 2004; 122:1616-28. [PMID: 15534122 PMCID: PMC1434792 DOI: 10.1001/archopht.122.11.1616] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To report findings regarding health-related quality-of-life outcomes by treatment arm, both overall and within subgroups defined by selected baseline characteristics, among patients who participated in the Submacular Surgery Trials (SST) randomized trial of observation vs surgical removal of subfoveal choroidal neovascular lesions that were either idiopathic or associated with ocular histoplasmosis (SST Group H Trial). DESIGN AND METHODS Eligible patients were 18 years or older and had subfoveal choroidal neovascularization (including a classic component on fluorescein angiography) and visual acuity of 20/50 to 20/800 inclusive in the eye randomly assigned to surgery or observation. Trained interviewers, who were masked to treatment assignment, administered the National Eye Institute Visual Function Questionnaire (NEI-VFQ), the 36-Item Short-Form Health Survey (SF-36), and the Hospital Anxiety and Depression Scale (HADS) by telephone before enrollment and at 6, 12, and 24 months after enrollment; early enrollees also had interviews at 36 and 48 months. Baseline clinical examinations provided data regarding visual acuity, other aspects of vision, and presence of unilateral or bilateral choroidal neovascularization. RESULTS Of 225 patients interviewed at baseline and enrolled, 201, 190, and 161 patients (respectively, 89%, 85%, and 88% of those eligible to be interviewed) were interviewed 12, 24, and 36 months later. The NEI-VFQ scores in both treatment arms improved from baseline (median score, 75) to the 24-month interview. Patients in the surgery arm had 4-point larger improvements, on average, than patients in the observation arm (95% confidence interval, 1-8 points). The largest differences between treatment arms for mean 24-month improvements from baseline were in the role difficulties subscale (9 points) and dependency subscale (8 points), with larger mean improvements in the surgery arm. Scores on the SF-36 worsened by approximately 1 point on the physical component summary and improved by 2 points or more on the mental component summary in both treatment arms by 24 months in comparison to baseline. The percentage of HADS-defined "definite cases" of both anxiety and depression declined from baseline in each treatment arm. CONCLUSIONS Vision-targeted quality of life improved more after submacular surgery than with observation, supporting a possible small overall benefit of surgery suggested by the ophthalmic outcomes reported elsewhere. Ophthalmologists and patients similar to those who participated in the SST Group H Trial should be aware of the effects of submacular surgery on specific aspects of vision-targeted quality of life as well as on ophthalmic outcomes when considering this treatment approach.
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Hawkins BS, Bressler NM, Bressler SB, Davidorf FH, Hoskins JC, Marsh MJ, Miskala PH, Redford M, Sternberg P, Thomas MA, Toth CA. Surgical removal vs observation for subfoveal choroidal neovascularization, either associated with the ocular histoplasmosis syndrome or idiopathic: I. Ophthalmic findings from a randomized clinical trial: Submacular Surgery Trials (SST) Group H Trial: SST Report No. 9. ACTA ACUST UNITED AC 2004; 122:1597-611. [PMID: 15534121 PMCID: PMC1256023 DOI: 10.1001/archopht.122.11.1597] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To present visual acuity findings and related outcomes from eyes of patients enrolled in a randomized trial conducted by the Submacular Surgery Trials (SST) Research Group (SST Group H Trial) to compare surgical removal vs observation of subfoveal choroidal neovascular lesions that were either idiopathic or associated with ocular histoplasmosis. METHODS Eligible patients 18 years or older had subfoveal choroidal neovascularization (new or recurrent) that included a classic component on fluorescein angiography and best-corrected visual acuity of 20/50 to 20/800 in 1 eye ("study eye"). Patients were examined 3, 6, 12, and 24 months after enrollment to assess study outcomes and adverse events. Best-corrected visual acuity was measured by a masked examiner at the 24-month examination. A successful outcome was defined a priori as 24-month visual acuity better or no more than 1 line (7 letters) worse than at baseline. RESULTS Among 225 patients enrolled (median visual acuity 20/100), 113 study eyes were assigned to observation and 112 to surgery. Forty-six percent of the eyes in the observation arm and 55% in the surgery arm had a successful outcome (success ratio, 1.18; 95% confidence interval, 0.89-1.56). Median visual acuity at the 24-month examination was 20/250 among eyes in the observation arm and 20/160 for eyes in the surgery arm. The prespecified subgroup of eyes with visual acuity worse than 20/100 at baseline (n = 92) had more successes with surgery; 31 (76%) of 41 eyes in the surgery arm vs 20 (50%) of 40 eyes in the observation arm examined at 24 months (success ratio, 1.53; 95% confidence interval, 1.08-2.16). Five (4%) of 111 eyes in the surgery arm subsequently had a rhegmatogenous retinal detachment. Twenty-seven (24%) of 112 initially phakic eyes in the surgery arm (none in the observation arm) had cataract surgery during follow-up, all among patients older than 50 years. Recurrent choroidal neovascularization developed by the 24-month examination in 58% of surgically treated eyes. CONCLUSIONS Overall, findings supported no benefit or a smaller benefit to surgery than the trial was designed to detect. Findings support consideration of surgery for eyes with subfoveal choroidal neovascularization and best-corrected visual acuity worse than 20/100 that meet other eligibility criteria for the SST Group H Trial. Other factors that may influence the treatment decision include the risks of retinal detachment, cataract among older patients, and recurrent choroidal neovascularization and the possibility that additional treatment will be required after submacular surgery.
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Lee JT, Dixon MR, Murrell Z, Konyalian V, Agbunag R, Rostami S, French S, Kumar RR. Colonic histoplasmosis presenting as colon cancer in the nonimmunocompromised patient: report of a case and review of the literature. Am Surg 2004; 70:959-63. [PMID: 15586505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Histoplasma capsulatum is an important pathogen that is the most commonly diagnosed endemic mycosis in the gastrointestinal tract of immunocompromised hosts. Failure to recognize and treat disseminated histoplasmosis in AIDS patients invariably leads to death. Gastrointestinal manifestations frequently involve the terminal ileum and cecum, and depending on the layer of bowel wall involved present as bleeding, obstruction, perforation, or peritonitis. Because they can be variable in appearance, they may be mistaken for Crohn's disease or malignant tumors. Four distinct pathologic patterns of GI histoplasmosis have been described that all have differing clinical presentations. We report a case of a non-AIDS patient who presented with a near-obstructing colonic mass suspicious for advanced malignancy but was found to have histoplasmosis on final pathology. The patient underwent successful operative resection, systemic anti-fungal therapy, and extensive workup for immunosuppressive disorders, which were negative. The patient was from an area in Mexico known to be endemic for histoplasmosis. This is the first report of a colonic mass lesion occurring in a non-AIDS patient, and review of the worldwide literature regarding GI histoplasmosis reveals excellent long-term survival with aggressive therapy. We discuss the surgical and medical management of colonic histoplasmosis in this report.
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Affiliation(s)
- Jason T Lee
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California 90509, USA
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19
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Affiliation(s)
- Mylene T Truong
- Department of Diagnostic Radiology, Box 57, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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Abstract
PURPOSE To describe the clinical and pathologic features of a conjunctival granuloma resulting from Histoplasma capsulatum. DESIGN Clinicopathologic case report. METHODS Surgical excision of conjunctival lesion, histopathologic study with special stains, and a fluorescent antibody technique. RESULTS A conjunctiva granuloma was found to contain microorganisms, compatible with H. capsulatum, confirmed by a fluorescent antibody technique. The conjunctiva returned to normal. CONCLUSIONS A focal granuloma of the conjunctiva contained H. capsulatum in a patient whose recent symptoms suggested primary infection. The conjunctival lesion was similar to mucocutaneous lesions seen in patients with systemic histoplasmosis.
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Affiliation(s)
- David L Knox
- Eye Pathology Laboratory, Wilmer Institute and Department of Pathology, Johns Hopkins Medical Institution, 600 North Wolfe Street, Baltimore, MD 21287-9248, USA
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21
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Rodríguez N, Sandoval M, Alsina A, Vidal C, del Sordo M, Muro F, Tiraboschi IN, Devés A, Mazza O. [Genital histoplasmosis. Presentation of a clinical case]. ARCH ESP UROL 2003; 56:462-6. [PMID: 12918301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVES On December 1905 Darling, resident histopathologist on the Panama Channel area, observed a parasite in the large mononuclear cells of different organs. Negroni in 1914 described the first Argentinean case. Lung, oral, nasal, and laryngeal involvement are common. On the other hand, genital involvement is uncommon. The objective of this war is to communicate the case of a patient with genital histoplasmosis. METHODS/RESULTS A 60-year-old Argentinian male started two years before with penile lesions and pruritus. Two partial penile resections had been performed in 1999, but pathology reports were not available. The lesions evolved towards ulceration and bleeding. Surgical toilette was carried out. A partial penectomy and glanuloplasty with an original technique were performed. Pathology revealed intracellular and extracellular spherical microorganisms. Morphologically it was histoplasma capsulatum. The histoplasmosis is an endemic mycosis. The infection takes place when inhaling the microconidiae of the fungus filamentous phase. Only a small number of people develop the disease after infection. Diagnosis is made by discovering of 2-3 micron yeasts with Giemsa stain. CONCLUSIONS If a patient from the histoplasmosis endemic area has a granular lesion, a mycotic disease should be considered.
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Affiliation(s)
- Norberto Rodríguez
- Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires, Sección Oncología Urológica, Buenos Aires, Argentina
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Hott JS, Horn E, Sonntag VKH, Coons SW, Shetter A. Intramedullary histoplasmosis spinal cord abscess in a nonendemic region: case report and review of the literature. J Spinal Disord Tech 2003; 16:212-5. [PMID: 12679679 DOI: 10.1097/00024720-200304000-00016] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An immunocompetent patient from a nonendemic region developed a rare intramedullary thoracic histoplasmoma. A native Arizonan, with no history of travel to endemic regions, received 3 months of itraconazole for confirmed gastrointestinal histoplasmosis at an outside institution. Two years later she experienced the rapid onset of paraplegia and lost bowel and bladder function. Magnetic resonance imaging demonstrated a ring-enhancing intramedullary lesion at T2 and signal abnormality from C2 to T5. Emergent T2-T3 laminectomy was performed with ultrasonographically guided intradural exploration and midline myelotomy. The intramedullary abscess was drained. She was nonambulatory, but motor function was partially restored. An Ommaya reservoir was later placed to deliver amphotericin and a new antifungal agent, voriconazole. Magnetic resonance imaging confirmed that the infection had resolved. Intramedullary spinal histoplasmoma is a rare manifestation of disseminated histoplasmosis, particularly in nonendemic regions. Surgery for focal mass lesions and aggressive antifungal chemotherapy are the optimal treatment. Newer central nervous system-penetrating antibiotics show promise in refractory cases.
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Affiliation(s)
- Jonathan S Hott
- Divisions of Neurologic Surgery, Barrow Neurologic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Abstract
We describe a rare case of Histoplasma infection, which manifested only as a brain histoplasmoma, in a previously healthy woman who had no underlying predisposing conditions. Only a few cases of such intracranial histoplasmomas have been reported but this entity can mimic a brain neoplasm and should be a diagnostic consideration during the evaluation of ring-enhancing brain lesions.
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Affiliation(s)
- Niki I Paphitou
- Division of Infectious Diseases, The University of Texas-Houston Medical School, 77030, USA
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Klein AM, Spiro J, Lafreniere D. Histoplasmosis of the larynx: a case report. Ear Nose Throat J 2002; 81:309-10. [PMID: 12024998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Affiliation(s)
- Adam M Klein
- Division of Otolaryngology-Head and Neck Surgery, University of Connecticut, Farmington, USA
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25
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Chemaly RF, Tomford JW, Hall GS, Sholtis M, Chua JD, Procop GW. Rapid diagnosis of Histoplasma capsulatum endocarditis using the AccuProbe on an excised valve. J Clin Microbiol 2001; 39:2640-1. [PMID: 11427583 PMCID: PMC88199 DOI: 10.1128/jcm.39.7.2640-2641.2001] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Histoplasma capsulatum is an infrequent but serious cause of endocarditis. The definitive diagnosis requires culture, which may require a long incubation. We demonstrated the ability of the Histoplasma capsulatum AccuProbe to accurately identify this organism when applied directly on an excised valve that contained abundant yeast forms consistent with H. capsulatum.
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Affiliation(s)
- R F Chemaly
- Department of Clinical Pathology, Section of Clinical Microbiology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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26
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Martin RC, Edwards MJ, McMasters KM. Histoplasmosis as an isolated liver lesion: review and surgical therapy. Am Surg 2001; 67:430-1. [PMID: 11379642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Histoplasmosis is the most common cause of fungal infection in the Ohio River Valley of the United States. Ninety-nine per cent of patients exposed to histoplasmosis develop only subclinical infections. Liver involvement is common in disseminated histoplasmosis, which usually originates in the lungs. There has been only one prior case described in the literature of histoplasmosis presenting as an isolated liver mass. We report a rare case that presented as a solitary right-sided liver lesion invading the diaphragm, with review of the literature for therapy of histoplasmosis of the liver.
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Affiliation(s)
- R C Martin
- Department of Surgery, University of Louisville School of Medicine, Kentucky, USA
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27
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Abstract
A 37-yr-old man from Ecuador presented with abdominal pain, diarrhea, and weight loss. Endoscopy revealed duodenal histoplasmosis. The patient improved with antifungal therapy but was readmitted 2 yr later with diarrhea and fever. Colonoscopy revealed histoplasmosis lesions, including a constricting transverse colon lesion. The patient refused surgery and died of colonic perforation. We discuss the diagnosis and management of gastrointestinal histoplasmosis in this report.
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Affiliation(s)
- H Hertan
- Division of Gastroenterology, Our Lady of Mercy Medical Center, New York Medical College, Bronx 10466, USA
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Abstract
PURPOSE To report persistent open retinotomy after submacular surgery in patients with presumed ocular histoplasmosis. METHODS Retrospective review. Five eyes of 5 patients with submacular choroidal neovascularization associated with presumed ocular histoplasmosis had pars plana vitrectomy, detachment of the posterior hyaloid, and surgical removal of the neovascular complex using the small retinotomy technique. All eyes were followed postoperatively for a mean of 47 months (range, 36 to 73 months). RESULTS In all 5 patients, the open retinotomy persisted after submacular surgery. No complications were associated with the presence of an open retinotomy. CONCLUSION Persistence of the retinotomy site may occur after submacular surgery. With follow-up of at least 36 months, no significant complication is associated with an open retinotomy site.
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Affiliation(s)
- B A Cooper
- Department of Ophthalmology, Washington University, St. Louis, Missouri, USA
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29
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Uemura A. [Subretinal surgery for choroidal neovascularization]. Nippon Ganka Gakkai Zasshi 2000; 104:611-20. [PMID: 11031812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Ten years have passed since subretinal surgery for choroidal neovascularization (CNV) was developed. Many reports regarding the visual outcome after subretinal surgery have been published, which have revealed the role of the subretinal surgery, including long-term visual outcome and surgical complications. METHOD Reports associated with subretinal surgery published in the past decade were used to clarify the indication for surgery, visual outcome, and surgical complications. RESULTS The visual prognosis for patients with surgically excited CNV is variable, depending on the underlying disease. Patients with widespread defects of Bruch's membrane and retinal pigment epithelium (RPE), such as age-related macular degeneration, are probably not good candidates for surgery from the standpoint of recovering good visual acuity. On the other hand, patients with focal abnormalities in Bruch's membrane and the RPE, such as presumed ocular histoplasmosis or idiopathic CNV, may be good candidates for surgery. However, it has not been proved that subretinal surgery is superior to photocoagulation or observation. CONCLUSIONS For the time being, we have to select patients for subretinal surgery on the basis of published reports. The Submacular Surgery Trial now being held in the United States will evaluate the role of subretinal surgery in the management of patients with choroidal neovascularization.
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Affiliation(s)
- A Uemura
- Department of Ophthalmology Kagoshima University Faculty of Medicine, Japan
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30
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Abstract
PURPOSE To report pathologic examination of an excised choroidal neovascular membrane in a patient with ocular histoplasmosis syndrome that demonstrated granulomatous inflammation. METHOD Case report. A 50-year-old woman with sudden vision loss in her left eye demonstrated clinical and fluorescein angiographic findings characteristic of choroidal neovascularization secondary to ocular histoplasmosis syndrome. RESULTS Histopathologic examination of the surgically excised choroidal neovascular membrane disclosed granulomatous inflammation. CONCLUSIONS This case suggests an important role of mononuclear phagocytic cells as primary mediators of angiogenesis or modifiers of choroidal neovascularization. This association of choroidal neovascularization with granulomatous inflammation did not respond to treatment with systemic corticosteroids.
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Affiliation(s)
- E S Mann
- Department of Ophthalmology, Saint Louis University Health Sciences Center, St Louis, Missouri, USA.
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31
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Abstract
PURPOSE To evaluate the possible association between the development of choroidal neovascularization (CNV) and pregnancy. METHODS A retrospective review was performed of the clinical records of three patients who were pregnant at the time a choroidal neovascular membrane (CNVM) was diagnosed. The clinical presentations and treatment of the CNVM occurring in association with the pregnancies are described. RESULTS Each patient had a decrease in visual acuity during her pregnancy: one in the first trimester, one in the second trimester, and one in the third trimester. Two patients were diagnosed with CNV related to presumed ocular histoplasmosis syndrome (POHS) and one with an idiopathic CNVM. The two-patients with POHS showed progression of CNV after childbirth. All patients received laser photocoagulation directly to the site of the CNV. The two patients with ocular histoplasmosis experienced recurrence after treatment; one received further photocoagulation treatment, and the other underwent vitrectomy with removal of the CNVM. CONCLUSIONS Pregnancy and the immediate postpartum period may be associated with development or recurrence of CNV in POHS or idiopathic cases. This may be related to hormonal changes during pregnancy, or the cases described may reflect only a coincidental association. This report discusses possible causal factors and mechanisms.
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Affiliation(s)
- P Rhee
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, USA
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Sakamoto K, Kase M, Nagatomo A, Kunikane H, Okamoto H, Watanabe K. [Pulmonary histoplasmosis exhibiting solitary pulmonary nodule resected by thoracoscopic surgery: a case report and review of the Japanese literature]. Nihon Kokyuki Gakkai Zasshi 1999; 37:909-914. [PMID: 18217314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We reported a case of pulmonary histoplasmosis showing solitary nodular shadow. A 43-year-old man was referred to our hospital because of an abnormal shadow on chest X-ray films during a routine checkup. He had traveled to Honduras for 7 days. Chest computed tomographic (CT) scans showed a 13 x 12 mm nodular shadow with unclear margin in the left upper lobe (S3). Both transbronchial lung biopsy and CT guided transcutaneous needle biopsy failed to yield a definitive diagnosis. Thoracoscopic resection of the nodule was performed due to suspicion of lung cancer. Pathologically, the nodule displayed central caseous necrosis with many round yeast-like fungi. The fungi measured 3 to 4 microns in diameter and were well-stained by Grocott stain. Immunohistochemical staining was positive for anti-Histoplasma capsulatum antibody, resulting in the final diagnosis of pulmonary histoplasmosis. The patient's postoperative course was uneventful, and no recurrence was observed. Histoplasmosis is a rare disease in Japan. However, it is important to keep imported infectious diseases in mind when examining and treating patients who have a history of travel abroad.
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Affiliation(s)
- K Sakamoto
- Department of Thoracic Surgery, Yokohama Municipal Citizen's Hospital
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Schnader J, Pina EM, Baughman RP, Glassroth J, Adebonojo S. Clinical conference on management dilemmas: progressive pneumonia in a patient receiving long-term steroid therapy. Chest 1999; 115:260-6. [PMID: 9925094 DOI: 10.1378/chest.115.1.260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- J Schnader
- Department of Medicine, Wright State University School of Medicine, Dayton VA Medical Center, OH 45428, USA.
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Endo S, Murayama F, Yamaguchi T, Hasegawa T, Sohara Y, Fuse K, Fujii T, Saito K. Pulmonary histoplasmosis in a Japanese male: report of a case. Surg Today 1999; 28:1316-8. [PMID: 9872559 DOI: 10.1007/bf02482825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A case of pulmonary histoplasmosis, which is rare in Japan, is reported herein. A 43-year-old man who had worked in Mexico for 2 years and had come back to Japan 3 months earlier, presented at our hospital because of an abnormal shadow on his chest roentogenogram with no symptoms. His chest roentogenogram as well as chest computed tomograms revealed a 2-cm-diameter nodule in the anterior basal segment of his right lung and an enlargement of the subcarinal lymph node. Although these pictures seemed to indicate an advanced lung cancer, no malignant cells were found based on the brushing cytology findings after bronchoscopy. An exploratory thoracoscopic tumor resection and biopsy of the enlarged lymph node led to a histological diagnosis of an abscess due to histoplasma. The hospital course was uneventful. Postoperatively, amphotericin B was administered for 1 year. This is the eighth case of pulmonary histoplasmosis reported in Japan. A pulmonary nodule together with mediastinal lymphoadenopathy seems to be characteristic in these patients. Histoplasmosis should therefore be considered in the differential diagnosis, since overseas travel has now become common-place for the Japanese.
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Affiliation(s)
- S Endo
- Department of Thoracic Surgery, Jichi Medical School, Tochigi, Japan
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Abstract
The article deals with the case of an inflammatory pseudotumour of the lung in conjunction with histoplasmosis of the hilar lymph glands in a 35-year-old immunocompetent woman in a non-endemic area. She had been suffering from headaches and painful swelling of the lower legs, reddening and hyperthermia for 1.5 years. In addition to the above-mentioned symptoms she also complained of a typical flush syndrome which had begun a year later. The main paraclinical finding was a round mass in the right lung in chest radiography. After considering various differential diagnostic possibilities, thoracotomy and resection of the upper lobe of the right lung were performed. The histological diagnosis of the material removed was that of an inflammatory pseudotumour of the lung, combined with histoplasmosis of the hilar lymph glands. Following a postoperative period without complications, antimycotic treatment was performed. The discussion includes whether the simultaneous occurrence of these two diseases is coincidental or whether there is a causal relation between the two. The authors also discuss various treatments with reference to the relevant literature.
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Affiliation(s)
- A Frey
- Chirurgische Klinik I, Zentrum für Chirurgie der Universität Leipzig
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Abstract
BACKGROUND The use of video-assisted thoracic surgery for diagnosis and treatment of mediastinal tumors in a multiinstitution patient population is not well understood. METHODS We studied 48 cases from Cancer and Leukemia Group B thoracic surgeons. Of 21 men and 27 women, aged 41 +/- 16 years, 22 patients were asymptomatic. In the others, 92% of tumor-related symptoms improved or resolved after treatment. Five tumors involved the anterior compartment, 19 the middle, and 24 the posterior compartment. Diagnoses were typical for each compartment but also included uncommon problems such as superior vena cava hemangioma and a histoplasmosis cyst causing hoarseness. Of the lesions, a biopsy of 12 was done without excision and the rest were excised completely. Fifteen were cystic and 10 were malignant (8 biopsy only). Maximal dimensions were 5.2 +/- 3.3 cm. RESULTS Operations were briefer for 24 posterior (93 +/- 41 min) than 5 anterior (195 +/- 46 min, p < 0.01) or 19 middle mediastinal tumors (170 +/- 78 min, p < 0.01). Although 96% had vital mediastinal relations, only six open conversions were performed because of bleeding (n = 3), large size, impaired exposure, or rib attachments, and no patient had morbidity beyond that expected for the thoracotomy. Postoperative stay was shorter for the nonconversion group (3.2 +/- 2.8 versus 5.5 +/- 2.1 days, p = 0.05), as was chest tube duration (1.7 +/- 1.4 days versus 3.2 +/- 1.9 days, p = 0.03). There were no postoperative deaths or major complications, but 7 patients had minor complications. During a mean of 20 months of surveillance (range, 1 to 52 months), one cyst recurred (asymptomatic) as did one sarcoma that was excised. CONCLUSIONS Video-assisted thoracic surgery is a safe technique for benign mediastinal tumors, typically those in the middle and posterior mediastinum.
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Affiliation(s)
- T L Demmy
- Division of Cardiothoracic Surgery, University of Missouri Hospital and Clinics, Columbia, USA
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Gonvers M, Uffer S, Bovey E. [Surgery of sub-foveal neovascular membranes]. Klin Monbl Augenheilkd 1998; 212:334-8. [PMID: 9677572 DOI: 10.1055/s-2008-1034899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND To present the functional, angiographic and electron microscopic results of 3 patients who underwent surgical removal of a subfoveolar neovascularisation. These patients are representative of the most common indications for subfoveolar surgery. MATERIAL AND METHOD In one case, the neovascularization originated from an old chorioretinal scar close to the macula; in another case, it was associated with high myopia; in the last case the neovascularization was coupled with an age-related macular degeneration (ARMD). The 3 removal neovascular membranes were examined by electron microscopy. Indocyanine green and fluorescein angiographies were performed in all 3 cases before and after surgery. RESULTS Visual recovery was excellent in the case of neovasularization and old chorioretinitis scar; it was minimal in the case of high myopia; no objective improvement was found in the case of ARMD. Electron microscopic examination did not always allow to determine accurately if the neovascularization was located in the subretinal space or under the pigment epthelium. CONCLUSIONS These results match those already published: surgical prognosis is the best when neovascularization is in the subretinal space and when the pigment epithelium has not been damaged by the underlying disease or by the surgical maneuvers. Electron microscopic examination is not easy to interpret.
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Affiliation(s)
- M Gonvers
- Clinique ophtalmologique universitaire, Lausanne
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Wolf S, Kirchhof B. [Subretinal surgery in choroid neovascularization]. Ophthalmologe 1997; 94:929-32. [PMID: 9487766 DOI: 10.1007/s003470050224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- S Wolf
- Augenklinik, Medizinische Fakultät, RWTH Aachen
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40
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Cuguilliere A, Maslin J, Raillat A, Auvray E, Lonjon T, Miltgen J, Branquet D, Cador L, Martet G, Bonnet D. [A tropical pulmonary nodule]. Rev Pneumol Clin 1997; 53:198-202. [PMID: 9616819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The authors report a case of american pulmonary histoplasmosis discovered by chance on a chest radiograph in a non immunocompromised patient, back from a stay in French Guyana. Confronted with the negativity of usual mycotic research, diagnosis has been made thanks to wedge excision by video-assisted thoracic surgery. The authors briefly sum up the recent facts regarding this imported infection, stressing the interest of a direct approach by surgical practices not very invasive that allow to eliminate with certainty neoplasm or tuberculosis.
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Affiliation(s)
- A Cuguilliere
- Service de Pneumologie, Hôpital d'Instruction des Armées Laveran, Marseille Armées
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Akduman L, Del Priore LV, Desai VN, Olk RJ, Kaplan HJ. Perfusion of the subfoveal choriocapillaris affects visual recovery after submacular surgery in presumed ocular histoplasmosis syndrome. Am J Ophthalmol 1997; 123:90-6. [PMID: 9186102 DOI: 10.1016/s0002-9394(14)70997-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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 occular 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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Affiliation(s)
- L Akduman
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri 63110-1096, USA
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Vasen W, Boerr L, Calzetti D, Arechabala A. [Intestinal subocclusion by disseminated histoplasmosis in an HIV-positive patient]. Gastroenterol Hepatol 1997; 20:24-6. [PMID: 9072193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- W Vasen
- Hospital Municipal de Gastroenterología Dr. Carlos Bonorio Udaondo, Argentina
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Affiliation(s)
- M T Camacho
- Department of Cardiothoracic Surgery, Montefiore Medical Center, Bronx, N.Y., USA
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Spivak H, Schlasinger MH, Tabanda-Lichauco R, Ferstenberg H. Small bowel obstruction from gastrointestinal histoplasmosis in acquired immune deficiency syndrome. Am Surg 1996; 62:369-72. [PMID: 8615564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Disseminated histoplasmosis is a rare condition that is associated with an underlying immune disorder in approximately 25 per cent of patients. It often leads to GI histoplasmosis, but when the disease predominantly affects the GI tract few, if any, pulmonary symptoms appear. Although histoplasmosis of the gastrointestinal system has been described, it rarely causes a small bowel obstruction. In fact, a recent review of the English literature revealed 77 cases of gastrointestinal histoplasmosis, with only none having clinical presentation solely involving of the jejunum and ileum in acquired immune deficiency syndrome (AIDS) patients. At the time of urgent abdominal exploration, both patients had several areas of bowel strictures with subjacent mesenteric adenopathy. They required resection of small bowel segments. Pathology examination established the diagnosis of histoplasmosis, and both patients were discharged home after antifungal therapy.
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Affiliation(s)
- H Spivak
- Department of Surgery, Beth Israel Medical Center, New York, New York, USA
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Abstract
Necrotizing myofascial fungal infections of the upper extremity is a rare event even in immunocompromised hosts. We report the course of a renal transplant patient who developed extensive necrotizing myofascial infection of an upper extremity secondary to Histoplasma capsulatum. Initial, functional, upper limb salvage was achieved after aggressive surgical debridement and high doses of amphotericin B. The patient ultimately succumbed to systemic fungal sepsis. The etiology and treatment of these infections are discussed.
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Affiliation(s)
- J D Wagner
- Department of Surgery, Indiana University Medical Center, Indianapolis, USA
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Abstract
PURPOSE Submacular surgery for choroidal neovascularization (CNV) is under investigation in the treatment of age-related macular degeneration (AMD) and the presumed ocular histoplasmosis syndrome. Four case studies are presented to demonstrate scanning laser ophthalmoscope (SLO) testing in the pre- and postsurgical evaluation of visual function in patients with subfoveal CNV secondary to AMD, presumed ocular histoplasmosis syndrome, and submacular hemorrhage secondary to AMD. METHODS Patients underwent a visual assessment pre- and 6 months postoperatively, consisting of low vision visual acuity measurement, SLO macular perimetry of dense and relative scotomas, and analysis of the preferred retinal locus for fixation (PRL) location and ability. RESULTS Visual acuity, dense and relative scotoma size and location, and PRL location were compared; and relationships between anatomic and functional changes were observed. Decreases in scotoma size and improvement in PRL location and ability usually corresponded with improved visual acuity. Preoperative scotoma and PRL location guided retinotomy site selection. CONCLUSION Scanning laser ophthalmoscope macular perimetry and PRL testing may be useful adjuncts in the visual assessment of submacular surgery and may advance under-standing of the effects of submacular surgery on visual function. In addition, this testing may be used to plan location of surgical interventions for macular diseases.
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Affiliation(s)
- N R Sabates
- Department of Ophthalmology, University of Missouri-Kansas City School of Medicine, Eye Foundation of Kansas, City 64108, USA
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Henry MA, Mendes EF, Saad LH, Rodrigues PA, Gonçalves I. [Esophageal histoplasmosis. A case report]. Arq Gastroenterol 1996; 33:26-8. [PMID: 8762683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The authors report a case of a patient with complaint of progressive disphagia. Stenoses of lower third of esophagus was revealed by radiological and endoscopic examinations. Fungi were showed in biopsy of lesion, with demonstration of Histoplasm capsulate by tissue culture. Endoscopic dilatation was performed because especific medical treatment failed but esophageal rupture was observed. Partial esophagectomy was performed with symptoms remission.
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Affiliation(s)
- M A Henry
- Departamento de Cirurgia e Ortopedia, Universidade Estadual Paulista, SP
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Abstract
The ocular histoplasmosis syndrome consists of punched-out, atrophic chorioretinal lesions, and peripapillary scarring in the absence of vitreal inflammation. Choroidal neovascularization is the cause of significant visual loss in involved eyes and is estimated to occur in up to 5% of affected eyes. An experimental primate model has given us a better understanding of the possible etiology and pathogenesis. Laser therapy for extrafoveal and juxtafoveal choroidal neovascularization has been shown to be effective. Recent advances in surgical technique and instrumentation have demonstrated the potential for the successful treatment of subfoveal choroidal neovascularization. The surgical specimens obtained from this approach have allowed for the study of the active process of neovascularization in this disease. This report summarizes our current knowledge regarding the pathogenesis and epidemiology of ocular histoplasmosis and the treatments currently utilized in the management of its associated choroidal neovascularization.
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Abstract
OBJECTIVE To determine the long-term visual outcome, rate of persistent choroidal neovascularization, and rate of recurrent choroidal neovascularization in eyes undergoing laser photocoagulation for choroidal neovascularization secondary to ocular histoplasmosis syndrome. DESIGN AND PATIENTS One hundred one eyes with 5 to 16 years of follow-up that presented with choroidal neovascularization secondary to ocular histoplasmosis were retrospectively evaluated. Patients were grouped according to location of choroidal neovascularization and assignment to observation or laser photocoagulation. MAIN OUTCOME MEASURES Visual acuity outcome and loss for all groups were compared. The rates of persistent and recurrent choroidal neovascularization for the treated eyes were also evaluated. RESULTS Visual acuity of 20/40 or better was obtained in 71% of eyes with treated extrafoveal choroidal neovascularization and 68% with treated juxtafoveal choroidal neovascularization. Recurrent choroidal neovascularization was observed in 23% of treated eyes during a mean follow-up of 9.6 years. CONCLUSION Results support the long-term benefit of photocoagulation and need for careful follow-up.
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Affiliation(s)
- H L Cummings
- Retina and Vitreous Associates of Kentucky, Lexington, USA
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