PMC5830978_01
Ultra-wide-field color photographs of the right eye (a) and left eye (b) at presentation showing peripapillary areas of hyper- and hypopigmentation and punched-out chorioretinal lesions in the midperipheral retina, findings classic for presumed ocular histoplasmosis syndrome. 30-degree fluorescein angiography of the right eye showed abnormal early hyperfluorescence in the fovea in the early frame (c) and intense leakage in the late frame (d).
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fig1
Dilated fundus examination of both eyes showed peripapillary hyper- and hypopigmentation and punched-out chorioretinal lesions in the midperipheral retina consistent with a diagnosis of POHS (Figures 1(a) and 1(b)). Fluorescein angiography (FA) of the right eye showed early hyperfluorescence in the fovea with intense leakage in the late frames, consistent with the presence of CNV (Figures 1(c) and 1(d)).
Spectral-domain optical coherence tomography images obtained at the patient's baseline visit (VA 20/70, CST 442, bevacizumab #1 given) (a); 1-month visit (VA 20/40, CST 263, bevacizumab #2 given) (b); 2-month visit (VA 20/32, CST 259, bevacizumab #3 given) (c); 4-month visit (VA 20/25, CST 253) (d); 6-month visit (VA 20/20, CST 257) (e). Between her 2-month and 6-month visits, the appearance of the fibrovascular PED remained stable with gradual decrease in the parafoveal intraretinal lipid. There was no recurrence of SRF or CME or change in PED size between her 4-month and 6-month visits, despite the lack of treatment. VA = visual acuity; CST = central subfield thickness; PED = pigment epithelial detachment; SRF = subretinal fluid; CME = cystoid macular edema.
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fig2
Intravitreal bevacizumab therapy was initiated with close follow-up using serial SD-OCT and OCTA images, shown in Figures 2 and 3, respectively.
Optical coherence tomography angiography images obtained at the patient's baseline visit (VA 20/70, bevacizumab #1 given) (a, f); 1-month visit (VA 20/40, bevacizumab #2 given) (b, g); 2-month visit (VA 20/32, bevacizumab #3 given) (c, h); 4-month visit (VA 20/25) (d, i); 6-month visit (VA 20/20) (e, j). (a) to (e) represented the outer retinal layer, while (f) to (j) represented the choriocapillaris layer. At her 4-month visit, the superior aspect of the CNV lesion (d) continued to regress following her bevacizumab #3 treatment given 2 months prior, while there was no change in the corresponding FA and OCT images. At her 6-month visit, there was subtle expansion of the superior aspect of the CNV lesion (e), while the corresponding FA and OCT images remained stable.
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fig3
Intravitreal bevacizumab therapy was initiated with close follow-up using serial SD-OCT and OCTA images, shown in Figures 2 and 3, respectively.
Fluorescein angiography (late frame) at the patient's baseline visit (VA 20/70, bevacizumab #1 given) (a); 2-month visit (VA 20/32, bevacizumab #3 given) (b); 4-month visit (VA 20/25) (c); 6-month visit (VA 20/20) (d). After the 2-month visit, there is complete resolution of leakage. VA = visual acuity.
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fig4
At her 2-month follow-up, the visual acuity of the right eye improved to 20/32, with no subretinal fluid (SRF) or CME on SD-OCT and resolution of leakage on FA (Figure 4).