Long term follow-up of Ocular Histoplasmosis in the Anti-VEGF Era

Abstract

Purpose : Since the advent and widespread off-label use of anti-vascular endothelial growth factor (anti-VEGF) for non-age-related macular degeneration associated choroidal neovascularization (CNV), few and limited studies have evaluated anti-VEGF effects on CNV associated with presumed ocular histoplasmosis (CNV-POHS). We performed a retrospective study to report the epidemiology, intravitreal treatment response, and long-term visual outcomes of patients with CNV-POHS treated with intravitreal anti-VEGF.

Methods : We reviewed the medical records of all subjects coded with a diagnosis of POHS who received intravitreal anti-VEGF at the University of Iowa from January 2004 to December 2014, and who had at least 1-year of follow-up. Data were compiled from 193 subjects meeting entry criteria. Data included subject age, pre- and post- treatment visual acuity and optical coherence tomographic (OCT) and fluorescein angiographic characteristics, if available.

Results : For the initial 24 eyes of 20 subjects, the average age at diagnosis of CNV-POHS was 42 years. Topographic CNV location was subfoveal in 19 eyes, peripapillary in 4 eyes and juxtafoveal in 1 eye. In eyes with OCT available for review at CNV-POHS diagnosis, 7 had subretinal hyperreflective material, 7 had intraretinal fluid, and 6 had subretinal fluid. The initial visual acuity ranged from 20/16-20/80, and the final visual acuity ranged from 20/15-20/70. On average, vision improved 2.6 lines. The mean total follow-up was 7 years (range 1-14 years), with a mean post-injection follow-up of 5 years (range 1-8 years). Mean number of injections given initially following CNV diagnosis was 5.5 (median 3), and the mean number of injections given for each reactivation was 5.4 injections (median 3). Thirteen eyes reactivated during the follow-up period, with 7 having only one reactivation, 1 having 2 reactivations, and 5 having 3 reactivations. The mean time to reactivation was 15.8 months.

Conclusions : Early analysis shows that over half of eyes with CNV-POHS treated with anti-VEGF required reinitiation of treatment. However, the overall visual acuity improved after treatment.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.