Subretinal endolaser photocoagulation 'of a recurrent juxtafoveal neovascular membrane in presumed ocular histoplasmosis syndrome

Purpose. Subfoveal endolaser has been previously applied to three eyes with subretinal membranes and age related macular degeneration with disappointing visual results. We report a case of recurrent, juxtafoveal choroidal neovascularization (CNV) in the presumed ocular histoplasmosis syndrome responding favorably to subretinal endolaser therapy. Methods. Following pars plana vitrectomy, hyaloid stripping, and retinotomy the neurosensory retina was elevated from an old extrafoveal laser scar. The CNV complex was adherent to the retinal pigment epithelium {RPE). In order to avoid extraction of juxtafoveal RPE, subretinal endolaser photocoagulation was applied to the membrane. The angled 31 gauge endolaser probe was used with settings of 0.2-0.5 seconds and 300 mW. Whitening of the underlying complex was observed. Results. Preoperative fundus exam and fluorescein angiography (FA) documented recurrent CNV extending to within 200 u of the fovea. Best corrected visual acuity (BCVA) was 20/200. BCVA at 3 months and 3 years following subretinal endolaser was 20/40. Fundus and FA evaluation revealed no evidence of a recurrent or persistent CNV complex. Conclusion. A recurrent juxtafoveal CNV complex, adherent to RPE at the time of removal was successfully treated with subretinal endolaser ohotocoaaulation. Further studv of similar casas mav be warranted.