K 469
Photodynamic therapy of subfoveal choroidal neovascularization associated with Presumed Ocular Histoplasmosis-Syndrome (POHS)
T. Behme
Introduction: POHS is a multifocal choroiditis with the following characteristics: numerous small- to medium-sized punched-out atrophic lesions ("histospots") in the fundus, a peripapillary pigmented scar and macular subretinal choroidal neovascularization (CNV). Patients age range from 20 to 50 years. In contrast to the real ocular histoplasmosis syndrome POHS occurs in regions where Histoplasma capsulatum is not endemic like the northwest of the USA, the Netherlands, Great Britain or Germany. The cause is unknown, a presumed connection to the fungus histoplasma capsulatum has not been proven. Visual outcome of patients treated by photocoagulation or surgical removal of the CNV is bad because of frequent recurrence of CNV (43%). Therefore early diagnosis has a special importance. Photodynamic therapy (PDT) with verteporfin (Visudyne®) is a new therapeutic method against subfoveal CNVs, witch is repeatable without loss of vision.
Methods: 4 patients with POHS and subfoveal CNV were treated with photodynamic therapy. All patients were examined with binocular ophthalmoscopy and fluorescein-angiography before and after treatment, the mean follow-up period was 9 months.
Results: All patients had an improvement of their visual acuity. The visual acuity increased on average from 20/40 to 20/25. One patient needed retreatment because off leakage off the CNV. No complications were recognized.
Discussion: In Germany POHS is a rare disease. PDT with verteporfin is a new treatment of subfoveal CNVs with no sideeffects and the benefit of improved visual acuity with good prognosis even after multiple retreatments. It is recommendable especially for those young patients.
Univ.-Augenklinik, Klinikum Benjamin Franklin, Freie Universität Berlin, Hindenburgdamm 30 , D - 12200 Berlin