IDIOPATHIC MULTIFOCAL WHITE DOT SYNDROMES
Dr George Papanikolaou
SHO in Ophthalmology,
Dept of Ophthalmology,
Singleton Hospital,
Swansea
MULTIPLE EVANESCENT WHITE DOT SYNDROMEMEWDS
Unilateral, Young myopic women, idiopathic, Excellent prognosis
Acute unilateral VA, photopsia, scotomata/ Viral prodrome
•Numerous migratory white dots (faint, PP, mid-periphery)
•Foveal granularity- Pathognomonic- PERSISTENT
•Mild papillitis/ vitritis/ disc oedema/ vasculitis
FFA: early punctate hyperfluorescence/ late: staining
ICG: typical multiple hypofluorescent spots throughout fundus
Hypofluorescence around optic nerve
VF: BS, disproportionate to clinical findings/ PERSISTENT
Recovery: 3-10/52, , no scarring
ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY/ APMPPE
Bilateral, young healthy adults, good prognosis
HLA-B7 ,DR2 / Influenza-like prodrome 50%
VA uni- bilateral in a few days
1. Creamy white placoid lesions at PP (RPE level)
2. Mild vitritis/ vessel sheathing/ disc oedema
FFA: early: dense hypofluorescence late: staining Inactive: window defect
ICG: Hypofluorescence (active+healed)
Systemic microvasculopathy (Skin, kidney, CNS)
Recovery: within 1/12, depigmentation and clumping
SERPIGENOUS CHOROIDOPATHY
Bilateral, chronic/ recurring, progressive, 40-60y, Poor prognosis
VA uni bilateral (asymmetric), Scotomata, Photopsiae
1. Active: Cream coloured,hazy borders, increasing brightness/ optic disccentrifugaly/ May start ANYWHERE/ Skip- satellite lesions/ Border inactive scars (DD APMPPE)/ Vascular predilection
2. Anterior uveitis/ vitritis
3. Inactive: choroidal atrophy (large chor. vessels)
FFA: early: central hypo+ hyper rim late: hyper leaks into the lesion (spotty staining) Healed: visible large choroidal vessels
CNVMNo systemic associationsRx: steroids, azathioprine, cyclosporine/ laser
BIRDSHOT CHORIORETINOPATHY/ BSR
Bilateral, women, middle age, guarded prognosisRemissions- exacerbations
HLA-A29 ( HIGHEST RR of any disease~200x)A29.2/ S-antigen/ CD8+/ Choroid + ret. vessels
Floaters, VA- nyctalopia- photopsia- colour vision
1. Creamy –yellow ovoid deep spots/ centrifugal/ nasal-inferior retina
2. Vitritis/ vasculitis/ narrowing of vessels3. CMO/ disc oedema4. Chronic: well defined atrophy/ NO PIGMENT
FFA: early: normal/ ‘Quenching’ of vessels
late: leakage (intraretinal, disc)ICG: hypo-, fuzzy choroidal vessels: ActivityRx: steroids/ immunosuppressants
PUNCTATE INNER CHOROIDOPATHYPIC
Bilateral, young myopic women, guarded prognosis
Scotomata/ photopsia/ Blurred vision
1. Small spots (same age),PP/ same as MCP
2. SRD
3. NO uveitis/vitritis
DD from POHS
Weeks to recover
Residual scars (with pigment)
CNVM
MULTIFOCAL CHOROIDITIS WITH PANUVEITIS
MCP
Uni bi, myopic, women, middle age, fair prognosis
Subacute blurring/ photopsiea/ scotomata/ floaters/ photophobia/ pain
1. Multiple, deep, yellow-grey lesions
2. Vitritis (all)/ ant. uveitis 50% (DD POHS)
3. Chronic: atrophy+pigmentation
FFA: early: hypo- late: fuzzy leaking
ICG: hypofl. spots- peripapillary
Recurrences (common)
CMO, Subretinal Fibrosis, CNVMRx: Steroids/ Imunosuppressants/ Laser
PRESUMED OCULAR HISTOPLASMOSIS SYNDROMEPOHS
H. capsulatum/ Missisipi- Ohio30-40yGood prognosis/ 2-10% ocular lesions in endemic areas 1/1000 maculopathy HLA DR2, HLA-B7Maculopathy
1. Histo spots (PP, midperiphery)/ linear streaks-equator
2. PPA
3. CNVM (v if macular spots)
4. Clear Vitreous, No PED
Positive skin testing/ serology/ CXR
Laser/ Surgical
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