Corticosteroids as an antiangiogenic agent for histoplasmosis-related subfoveal choroidal neovascularization

The purpose of this study was to evaluate the role of corticosteroids in ma naging subfoveal choroidal neovascularization (CNV) secondary to the presum ed ocular histoplasmosis syndrome. The cases of eighteen patients with histoplasmosis-related subfoveal CNV tr eated with corticosteroids were reviewed. Ten patients received oral predni sone for 4 to 6 weeks, and eight received a single sub-Tenon's injection of triamcinalone. Visual acuity outcomes were analyzed along with side effect profiles. At two-week follow-up, the prednisone group showed a median improvement in Snellen visual acuity of +2.0 lines, while the triamcinalone group remained essentially stable with a 0.5 line median loss. At treatment end (4 to 6 w eeks), both groups showed no significant change in median acuity at 0.0 and -1.0 lines, respectively. Median final vision at 3 months also remained es sentially stable at -0.5 lines for each group. Three patients reported anxi ety, all of whom were taking prednisone 80 mg daily. Two patients reported increased appetite and weight gain on regimens of prednisone 80 and 100 mg daily. There were no adverse effects reported in the other patients receivi ng oral prednisone or in any patient receiving sub-Tenon's triamcinalone. The results suggest a beneficial effect of corticosteroids in stabilizing s ubfoveal CNV secondary to ocular histoplasmosis. In this small series, oral prednisone resulted in a short-term improvement in visual acuity, which st abilized over longer follow-up. The sub-Tenon's triamcinalone group achieve d similar final stabilization without the initial improvement. Corticostero ids may be particularly valuable in managing neovascularization in patients who are awaiting interventions currently under development, in preventing recurrence after subfoveal surgery, or in treating non-surgical candidates. Further study is warranted to define the precise role of corticosteroids i n this condition.