This 45YO female has classic bilateral findings for atrophic ocular histoplasmosis (OHS), including the triad of peripapillary scarring, macular lesions, and scattered peripheral scars. Vision is 20/25 OD and 20/30 OS. All scars stain on fluorescein angiography.
We like to add a fourth criterion, a quiet vitreous, to this classic triad. The presence of vitreous inflammation or new lesions is not seen in OH and would suggest an alternative condition, such as multifocal choroiditis.
Learning Points:
Atrophic OHS does not require treatment, but patients with macular or peripapillary scarring need to be monitored due to the risk for macular neovascularization.
Treatment is similar to wet AMD, with anti-VEGF therapy usually being the first-line therapy. Unlike AMD, these patients often do not require ongoing injections.
Photodynamic therapy can help minimize treatment burden, and thermal laser therapy remains a good option for more peripheral macular lesions.
