Liem S E, Armbruster F C
Kittery Ophthalmic Consultants, Maine, USA.
J Am Optom Assoc. 1998 Aug;69(8):493-9.
Presumed ocular histoplasmosis syndrome (POHS) refers to a choroidopathy that is characterized by the presence of multiple peripheral atrophic chorioretinal scars, peri-papillary atrophy, and choroidal neovascular membranes (CNVM), usually in or adjacent to the fovea. In the United States, POHS is an important cause of loss of central visual acuity in patients between the ages of 20 and 50 years. A number of treatment options for subfoveal and juxtafoveal CNVMs in POHS have been under investigation, including laser photocoagulation, surgical excision of the CNVM, and radiation therapy.
A 28-year-old women was referred to our office reporting decreased depth perception and finger-counting vision in the right eye for the duration of 1 month. A diagnosis of POHS with subfoveal CNVM was made and the patient was referred for an experimental protocol of proton-beam irradiation. Four months after her initial visit, the patient returned, reporting blurry vision with a blind spot in her left eye. A subfoveal CNVM in the left eye was subsequently treated with irradiation as well. Seven months after the initial treatment, visual acuities were 20/20 in each treated eye.
Although is currently an experimental procedure, proton-beam irradiation appears to be a promising treatment for subfoveal CNVM in patients with POHS.
推测性眼组织胞浆菌病综合征（POHS）是一种脉络膜病变，其特征为存在多个周边萎缩性脉络膜视网膜瘢痕、视乳头周围萎缩以及脉络膜新生血管膜（CNVM），通常位于黄斑或其附近。在美国，POHS是20至50岁患者中心视力丧失的重要原因。针对POHS中黄斑下和黄斑旁CNVM的多种治疗选择一直在研究中，包括激光光凝、CNVM手术切除以及放射治疗。
一名28岁女性因右眼深度感知下降和只能数指视力1个月前来我处就诊。诊断为伴有黄斑下CNVM的POHS，该患者被转诊接受质子束照射的实验方案。首次就诊4个月后，患者复诊，称左眼视力模糊且有盲点。随后其左眼的黄斑下CNVM也接受了照射治疗。初始治疗7个月后，每只接受治疗的眼睛视力均为20/20。
虽然目前质子束照射是一种实验性程序，但它似乎是POHS患者黄斑下CNVM的一种有前景的治疗方法。
