多发性一过性白点综合征的临床和眼底血管造影特征

Clinical and fundus angiography characteristics of multiple evanescent white dot syndrome

目的观察多发性一过性白点综合征（MEWDS）的临床表现和眼底血管造影特征。方法经荧光素眼底血管造影（FFA）和吲哚青绿血管造影（ICGA）检查确诊的40例MEWDS患者40只眼的临床资料纳入研究。分析其临床特征、FFA和IcGA改变。结果40例患者均为单眼发病，其中，男性12例，女性28例；年龄16-64岁，平均年龄29．4岁。初诊时最佳矫正视力0．1～1．0，平均最佳矫正视力0．82。眼底检查均可见多个灰白色圆形斑点状病灶，直径约100～500μm，边界欠清晰；位于视网膜深层或视网膜色素上皮层。部分患者伴有轻度玻璃体混浊。FFA检查早期发现所有患者在白点状病灶对应部位可见有圆形或环形强荧光斑，晚期着染；18例患者出现视盘强荧光，并伴有视盘周围静脉渗漏；7例患者出现黄斑区强荧光斑。ICGA造影早期可见到视网膜后极部及周边部弱荧光斑，晚期持续存在，无明显渗漏；与FFA检查比较，其弱荧光斑数目多且明显。所有患者的主诉症状均在6～8周内消失。结论MEWDS患者眼底表现为多发性灰白色点状病灶；FFA早期表现为圆形强荧光和视网膜血管异常；ICGA检查可清晰显示视网膜后极部及中周部弱荧光斑，病灶数目明显多于FFA检查和检眼镜检查所见。

Objective To observe the clinical and fundus angiography characteristics of multiple evanescent white dot syndrome （MEWDS）. Methods Forty eyes of 40 patients （12 males/28 females） with MEWDS, diagnosed by fundus fluorescein angiography （FFA） or indocyanine green angiography （ICGA） were enrolled. All eases were unilateral. The age was ranged from 16 to 64 years old, with a mean of 29.4 years. The initial average corrected vision was ranged from 0.1 to 1.0, with a mean of 0. 82. The characteristics of clinical manifestations, the features of FFA and ICGA were analyzed. Results Multiple gray-white dots （100 - 500 μm） were found throughout the posterior pole and the mid-periphery areas. The lesions were at the depth of outer retina and retinal pigment epithelium layers. Some patients presented with mild vitreous opacity. FFA showed round or ring hyper-fluorescence spots at the early stage and tissue staining at the late stage, corresponding to the gray-white dots. Hyper-fluorescence spots and leakages at the retinal veins near optic disk were seen in 18 patients. The hyper-fluorescence spots near macular area were found in 7 patients. ICGA showed that numerous dark hypo-fluorescent clots in the mid-periphery and posterior pole at the early stage and no leakage at the late stage. ICGA detected more lesions than FFA. All of the patients were recovered without any visual complications within 6 - 8 weeks. Conclusions MEWDS patients have multiple fundus gray-white dots, and hyper-fluorescence and the abnormal retinal vessels by FFA, and multiple weak hypo-fluorescent spots throughout the posterior pole and the mid-periphery areas clearly on ICGA. The ICGA showed more lesions than the ophthalmoscope and FFA examination.