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Secondary open-angle glaucoma in presumed ocular histoplasmosis syndrome

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Purpose: Secondary glaucoma refers to any form of glaucoma in which there is an identifiable cause of increased eye pressure, resulting in optic nerve damage and vision loss. Presumed ocular histoplasmosis syndrome (POHS) is an infection caused by the fungus Histoplasma capsulatum. There are diverse ocular and systemic manifestations of POHS, ranging from influenza-like illness, cavitary lung disease to life threatening dissemination affecting multiple major organ systems. Once considered to be a public health threat mainly to Ohio, Mississippi River valley areas of the United States and South America, this case represents a new epidemiological report.

Results: Initial presentation of a young patient to our clinical service revealed several punched-out-chorioretinal lesions evident in the left eye. Secondary glaucoma was diagnosed in the left eye after Avastin injection to treat a choroidal neovascular membrane secondary to histoplasmosis. The patient was treated successfully with a topical simbrinza for the glaucoma.

Conclusion: The clinical presentation of histo-spots, peripapillary atrophy, and choroidal neovascularization represents a confirmed triad for POHS. Choroidal neovascular membranes can be a complication of POHS and anti-VEGF is a standard treatment. Certain anti-VEGF injections have been linked to sustained elevated intraocular pressure. From a public health perspective, we can look for POHS in other areas of the world where it is not usually and customarily found as well as monitor patients for prolonged increase in eye pressure after Avastin injection


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