Intravitreal triamcinolone for choroidal neovascularization in ocular histoplasmosis syndrome

doi:10.1016/S0002-9394(03)00389-1

American Journal of Ophthalmology

Volume 136, Issue 4, October 2003, Pages 739-741

https://doi.org/10.1016/S0002-9394(03)00389-1 Get rights and content

Abstract

Purpose

To report the effects of intravitreal triamcinolone acetonide injections for subfoveal and juxtafoveal choroidal neovascularization (CNV) in ocular histoplasmosis syndrome.

Methods

In a retrospective analysis, the proportion of eyes that gained ≥5 or lost ≥5 and ≥15 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters, best-corrected visual acuity using ETDRS letter score (VA), greatest linear dimension (GLD), and treatment side effects were assessed.

Results

Ten patients (five subfoveal, five juxtafoveal CNV; median follow-up: 17 months; range, 6–41 months) were evaluated. Thirty percent gained ≥5 letters, 20% lost 5 to 14 letters, and 50% maintained stable VA. Overall, mean VA and GLD remained stable. Side effects were transient intraocular pressure elevation and mild cataract development.

Conclusions

Intravitreal triamcinolone acetonide for CNV resulting from OHS was found to be relatively safe and showed good visual outcome for both subfoveal and juxtafoveal CNV. Further studies are warranted to evaluate this treatment.

References (4)

D.A. Saperstein et al.
Photodynamic therapy of subfoveal choroidal neovascularization with verteporfin in the ocular histoplasmosis syndromeone-year results of an uncontrolled, prospective case series
Ophthalmology
(2002)
S.L. Fine et al.
Laser treatment for subfoveal neovascular membranes in ocular histoplasmosis syndromeresults of a pilot randomized clinical trial
Arch Ophthalmol
(1993)

There are more references available in the full text version of this article.

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Given the overlap of clinical features of AEPVM with multifocal Best disease—of which CNV is a recognized but infrequent complication—it is not surprising that one of our patients demonstrated CNV (patient 2). The efficacy of a single intravitreal injection of triamcinolone acetonide in this patient is reminiscent of patients with CNV secondary to ocular inflammatory or infectious diseases such as idiopathic multifocal choroiditis or presumed ocular histoplasmosis syndrome.19–21 The degree to which systemic corticosteroids generally facilitate visual recovery in AEVPM is unclear, because most of the patients reported in the literature recovered without medical intervention.
To describe clinical findings in patients with acute exudative polymorphous vitelliform maculopathy (AEPVM).
Retrospective, observational, multicenter case series review.
Consecutive patients diagnosed with idiopathic AEPVM.
Review of clinical charts, multimodal imaging, electrophysiologic findings, and genetic findings in previously unpublished patients and review of the literature.
Clinical features of idiopathic AEPVM and differential diagnosis.
Eighteen patients (age range, 21–74 years) with typical features of AEPVM, including initial localized, serous detachments followed by the development of characteristic yellow-white deposits in the vitelliform space. Over time, this hyperautofluorescent material gravitated within the larger lesions, resulting in typical curvilinear deposits characteristic of later stages. Symptoms and clinical findings lasted from weeks to several years. Some patients showed previously undescribed features such as fluorescein-negative intraretinal cystic changes, choroidal neovascularization, serous retinal elevations mimicking retinal folds, increased choroidal thickness, lack of rapid visual recovery, and recurrence years after complete resolution of initial manifestations.
Acute exudative polymorphous vitelliform maculopathy can present with a more variable natural course than previously described. Paraneoplastic retinopathy and autosomal recessive bestrophinopathy closely resemble AEPVM, necessitating medical and hereditary evaluation to exclude these clinical possibilities. This series of patients with AEPVM expands the clinical spectrum of the disorder, including demographics, clinical manifestations, imaging features, natural course, and visual prognosis.
Treatment of CNV secondary to presumed ocular histoplasmosis with intravitreal aflibercept 2.0 mg injection
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This highly technical procedure carries a significant set of complications, including macular striae and retinal tears. Oral and intravitreal corticosteroids have also been shown to have a stabilizing effect; however, these treatments carry associated systemic and ocular complications.14,15 PDT also has an established role.
To assess the efficacy and safety of intravitreal aflibercept injection in the treatment of CNV secondary to presumed ocular histoplasmosis syndrome (POHS).
To assess safety of intravitreal aflibercept for the treatment of CNV secondary to presumed ocular histoplasmosis syndrome.
Masked, open-label, prospective study. Five subjects will receive 2.0 mg aflibercept injection every 8 weeks with 3 initial monthly doses over a 12 month period.
No adverse systemic or ocular were reported. At month six, the mean visual acuity improved by 7.8 ETDRS letters, mean central subfoveal thickness decreased by 38.8 microns and mean OCT volume decreased by 0.076 mm3 . At month twelve, the mean visual acuity improved by12.4 ETDRS letters, mean central subfoveal thickness decreased by 34.6 microns and mean OCT volume decreased by 0.576 mm3.
The use of intravitreal 2.0 mg aflibercept injection for the treatment of CNV secondary to presumed ocular histoplasmosis syndrome yielded no systemic or ocular adverse events and produced improvement in visual acuity and reduction of OCT thickness and volume.
Évaluer l’efficacité et l’innocuité de l’aflibercept intravitréen pour le traitement de la néovascularisation choroïdienne (NVC) secondaire au syndrome d’histoplasmose oculaire.
Étude prospective ouverte à l’insu.
Cinq sujets ont reçu 2,0 mg d’aflibercept intravitréen aux 8 semaines, avec 3 doses mensuelles initiales, sur une période de 12 mois.
Aucun événement indésirable, d’ordre systémique ou oculaire, n’a été noté. Au sixième mois, l’acuité visuelle moyenne s’était améliorée de 7,8 lettres ETDRS, l’épaisseur sous-fovéale centrale moyenne avait diminué de 38,8 microns et le volume TCO moyen avait diminué de 0,076 mm3. Au douzième mois, l’acuité visuelle moyenne s’était améliorée de 12,4 lettres ETDRS, l’épaisseur sous-fovéale centrale moyenne avait diminué de 34,6 microns et le volume TCO moyen avait diminué de 0,576 mm3.
L’administration de doses de 2,0 mg d’aflibercept intravitréen pour le traitement de la NVC secondaire au syndrome d’histoplasmose oculaire n’a donné lieu à aucun événement indésirable, d’ordre systémique ou oculaire, et a produit une amélioration de l’acuité visuelle et une réduction de l’épaisseur et du volume mesurés par TCO.
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The use of macular translocation surgery has been abandoned because the VA outcomes are not superior to anti-VEGF injections, and the risk of perioperative complications, including proliferative vitreoretinopathy, is relatively high. A small retrospective study analyzed the effect of intravitreal triamcinolone for CNV secondary to OHS.115 Ten patients received 0.1 mg of triamcinolone for subfoveal (5/10) or juxtafoveal (5/10) CNVs.
Ocular histoplasmosis syndrome (OHS) is a chorioretinal disorder with a distinct fundus appearance that is commonly found in regions endemic for Histoplasma capsulatum. Choroidal neovascularization (CNV) secondary to OHS is considered one of the principal causes of central vision loss among young adults in endemic areas. Although there is no consensus regarding its pathogenesis, evidence points to Histoplasma capsulatum as the most probable etiology. Once considered an intractable hemorrhagic maculopathy, CNVs are now treatable. Extrafoveal CNVs are successfully treated with laser photocoagulation. Subfoveal and juxtafoveal CNVs are managed with anti-vascular endothelial growth factor therapy, photodynamic therapy, or a combination of both. Modern imaging technologies such as spectral-domain optical coherence tomography have improved our diagnostic abilities, making it easier to monitor disease activity and CNV regression. We review the epidemiology, pathogenesis, clinical manifestations, differential diagnosis, and current treatment of this disease.
Objective area measurement technique for choroidal neovascularization from fluorescein angiography
2014, Microvascular Research
Citation Excerpt :
A second group of three rats received a 5 μl injection of 40 mg/ml triamcinolone acetonide (TA) (Kenalog®-40, Bristol-Myers Squibb, New York, NY). Intravitreal injections of TA have been shown to play a role in improving CNV in both humans (Challa et al., 1998; Rechtman et al., 2003) and laser-induced rat models of CNV (Ciulla et al., 2001; Kim and Toma, 2010). A third group of five rats received a 5 μl injection of thermo-responsive hydrogel containing a suspension of dexamethasone sodium phosphate (DSP)-loaded nanospheres.
The purpose of this study was to develop a non-biased method of quantitatively measuring choroidal neovascularization (CNV) areas based on late-phase fluorescein angiography (FA) images. Experimental CNV was induced in Long Evans rats by laser disruption of the Bruch's membrane. FA was performed weekly for 5 weeks. Multi-Otsu thresholding (MOT) was used to quantify CNV in late-phase FA images from both experimental rodent CNV and wet age-related macular degeneration (wAMD) patients. Images were automatically thresholded into three levels based on the image histogram, with the highest level containing CNV. To determine the technique's ability to quantify CNV areas, rats were given either triamcinolone acetonide or dexamethasone sodium phosphate to treat CNV and compared to untreated rats. The rat CNV lesion areas measured from 5-week histology sections from each treatment group were compared to areas measured from the corresponding FA images. MOT was able to detect statistical decreases in rodent CNV area in the treatment groups versus control from weeks 3 through 5. The ratio of CNV area measured from histology to area measured from FA images was not statistically different between groups. Finally, to determine the usefulness of MOT on pathological morphologies of CNV, MOT was performed on late-phase FA images from patients with classic and diffuse CNV. The technique was able to segment classical CNV in wAMD patients, but performed poorly with diffuse CNV. MOT provides a robust, objective, and quantifiable area measurement of CNV lesion area in both experimentally-induced and pathological CNV. The results indicate that MOT could be a useful research tool in helping evaluate the effects of therapeutics on CNV growth.

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Brief reportIntravitreal triamcinolone for choroidal neovascularization in ocular histoplasmosis syndrome☆

Abstract

Purpose

Methods

Results

Conclusions

Ophthalmology

Laser treatment for subfoveal neovascular membranes in ocular histoplasmosis syndromeresults of a pilot randomized clinical trial

Arch Ophthalmol

Brief report
Intravitreal triamcinolone for choroidal neovascularization in ocular histoplasmosis syndrome☆