Ocular Histoplasmosis - not many spots

This montage is of a 65 year-old-female patient with ocular histoplasmosis. Artifacts from the imaging are denoted by green arrows. This case is atypical because there are not many punched out midperipheral “histo spots”. However, the peripapillary scarring of the left eye (turquoise arrows) is characteristic of ocular histoplasmosis. The right eye has choroidal neovascularization (yellow arrows), which is a common secondary complication of ocular histoplasmosis that responds to injections of anti-vascular endothelial growth factor drugs such as bevacizumab. The OCT shows the choroidal neovascularization with associated scar tissue as a hyperreflective subretinal lesion in the right eye (green arrow). Overlying the lesion is subretinal fluid, which is hyporeflective (red arrow). The OCT of the left eye shows the peripapillary scarring as an absent retinal pigment epithelial and ellipsoid zone line (purple arrow).