[Focal hemorrhagic chorioretinopathy. Clinical differentiation and visual prognosis]

Macular choroidal neovascularization in young adults without any known underlying diseases is referred to under the general term of focal hemorrhagic chorioretinopathy. In endemic areas of the USA an infection with Histoplasma capsulatum is thought to be the causative agent, but in Europe the pathogenesis of this condition is unknown. With the aim of finding how European patients with this disease might be detected by clinical examination and to estimate the prognosis for sight in the affected eye and the fellow eye, a follow-up examination (follow up 1-24 years, mean 7 years) of 88 patients (age 15-48 years, mean 33.6 years) was undertaken. Most patients were between 20 and 40 years of age and mildly myopic. The number of chorioatrophic scars associated with the choroidal neovascularization in particular varied widely between patients. Therefore, this characteristic is most useful for clinical differentiation between patients. In contrast, the development of an atrophic conus at the optic disc was predominantly correlated with worsening myopia. One-third of all patients experienced decreased vision during follow-up. In two-thirds of the group, however, the final vision was still 0.1 or better. The initial visual prognosis in the eye affected was predominantly dependent upon the location of the neovascular membrane in relation to the fovea and therefore upon the possibility of photocoagulation treatment. Long-term follow up in these patients revealed visual acuity decreased further only in eyes with increasing atrophy of the retinal pigment epithelium surrounding the disciform or laser scar. One-fifth of the patients also developed choroidal neovascularization in the fellow eye.(ABSTRACT TRUNCATED AT 250 WORDS)