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Case 9-6, Presumed Ocular Histoplasmosis Syndrome

Clinical Summary

A 45-year-old man with a history of presumed ocular histoplasmosis reported mild distortion and blurring in his left eye since his most recent laser treatment. His visual acuity was assessed at 20/60, Dilated fundus examination (A) revealed a dry laser scar inferior to fixation, multiple punched-out chorioretinal scars throughout the posterior pole, and very mild peripapillary atrophy. A thin sub retinal hemorrhage was noted in the central macula. A small depigmented area that appeared to be choroidal neovascularization was observed just superior to the fovea, Fluorescein angiography (B) showed a crescent of hvperil uorescence inferior to the center consistent with previous laser treatment. A small, well-demarcated area of hy-perfluorescence superior to the fovea exhibited increasing intensity as the angiogram progressed consistent with a neovascular membrane.

Optical Coherence Tomography

A vertical OCT image (C) through fixation displayed the contour of the fovea 1 pit, Inferior to the center, there was increased backscattering from the layers below the retinal pigment epithelium (RPE) consistent with a laser scar. The reflection from the RPE and choriocapillaris adjacent to the scar immediately superior to the fovea appeared to be fragmented corresponding to the neovascular membrane observed clinically

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