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G.M. Comer, T.A. Ciulla, H. Gao, R.K. Maturi; Treatment Outcomes of Choroidal Neovascularization Secondary to Ocular Histoplasmosis . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4070.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To compare the treatment outcomes of intravitreal corticosteroids, photodynamic therapy, or both on choroidal neovascularization (CNV) secondary to ocular histoplasmosis syndrome (OHS). Methods: In this retrospective analysis, 26 subjects with new–onset subfoveal or juxtafoveal CNV secondary to OHS received either 4 milligrams (mg) intravitreal triamcinolone acetonide (Kenalog) (IVK) (n=11), 6 mg/square meter photodynamic therapy with verteporfin (PDT) (n=10), or both (PDT/IVK) (n=5). Relative changes of Snellen visual acuity (VA), intraocular pressure (IOP), and cataract progression were assessed for up to 12 months. Results: PDT alone demonstrated a statistically significant (p=0.02) improvement in VA over baseline for up to 6 months when the single case of sudden, severe vision loss was eliminated. No significant changes were noted for IOP, cataract progression, or VA after 6 months. IVK alone demonstrated a trend towards significance at 3 months for VA (p=0.07) and elevated IOP (p=0.06), which reached statistical significance at 6 months (p=0.03) for VA improvement over baseline. No differences were detected for VA after 6 months, IOP after 3 months, or cataract progression. PDT/IVK did not reveal any differences in VA, IOP, or cataract progression over baseline at any time period. When directly comparing PDT verses IVK, no differences were detected in VA or cataract progession; however, IVK subjects had a higher IOP (p=0.005), which was adequately controlled with topical medication when indicated. When comparing PDT to PDT/IVK, the VA was better for PDT alone (p=0.04) at 6 months but not statistically significant at 3, 9, or 12 months when the subject with severe, sudden vision loss was eliminated from the PDT group. IOP and cataract progression were not significantly different between the two groups. IVK verses PDT/IVK revealed a trend towards improved VA with the IVK group (p=0.09) at 6 months but no difference at 3, 9, or 12 months. IOP and cataract progression were not significantly different. Conclusions: IVK and PDT alone are both valid options for short–term improvement of VA in new onset subfoveal and juxtafoveal CNV secondary to OHS. However, the combination of IVK and PDT did not demonstrate superior efficacy verses each agent alone. Further studies with larger numbers are needed.
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