This is also the rarest form with most cases requiring enucleation of the eye.[16] The other forms of the disease require a pre-existing medical condition, usually associated with thalassemic hemoglobinopathy.[15] Prognosis is poor to guarded and treatments include aggressive surgical resection of infected tissue, with amputation suggested if the infection is limited to a distal limb followed by immunotherapy and chemotherapy.[16] A recently published review lists nine cases of vascular pythiosis with five survivors receiving surgery with free margins and all except one requiring amputation.