多发性一过性白点综合征眼底吲哚青绿血管造影图像特征意义

The optical imaging features and clinical significances of the multiple evanescent white dot syndrome

目的研究多发性一过性白点综合征（MEWDS）眼底白色斑点在眼底吲哚青绿血管造影（ICGA）检查中的图像特征及临床意义。方法对2009年1月至2010年12月在邢台市眼科医院就诊的8例8只眼临床确诊的MEWDS患者用HAR-2进行眼底彩色拍照、眼底荧光素血管造影（FFA）和ICGA同步检查，对比观察在眼底彩照、FFA及ICGA检查中的图像特征，重点观察眼底白色斑点在ICGA中的表现。结果8只眼的眼底白色斑点在FFA早期均呈圆形强荧光斑，后期呈强荧光染色。ICGA早期8只眼眼底白色斑点对应处均无明显异常荧光改变，后期8只眼眼底均可见多个或大量斑点或斑片状弱荧光灶散在或弥漫分布。通过对比，ICGA后期像中的弱荧光灶不仅比眼底彩照中的白色斑点及FFA中的强荧光灶显示地更加清晰，而且在数量上也明显增多。通过随访，发现患者痊愈后眼底白色斑点能够完全消退，并且2例患者复查FFA及ICGA检查证实初诊时眼底白色斑点在FFA及ICGA检查中的异常荧光改变均完全恢复。结论MEWDS眼底白色斑点在ICGA早期为正常荧光像，后期呈斑点或斑片状弱荧光是其特征性改变；且随着病变痊愈，这种特征性改变能够完全消退。MEWDS在ICGA中的这种特征性改变对临床诊断、鉴别诊断及随访有重要的价值。

Objective To study the imaging features and clinical significances of lesions in a case series of multiple evanescent white dot syndrome （MEWDS） in indocyanine green angiography （ICGA）. Methods Eight eyes of 8 cases diagnosed as MEWDS studied using the color fundus pho- tograph, fundus fluorescein angiography （FFA） and ICGA checks of HAR2. The image features of the fundus color photograph, FFA and ICGA were analyzed by contrast, mainly observed the performance of the spots in ICGA. Results The white spots of 8 eyes （100%） showed hyperfluorescence during the early phase and were staining during the late phase on FFA. The white spots of 8 eyes （100%） were almost normal fluorescence image during the early phase on ICGA, but there were multiple hypofluorescence lesions scattered in the fundus during the late stage. Not only the hypofluorescence lesions of the fundus in the ICGA showed more clearly than the white spots in the color fundus photograph and the hyperfluorescence lesions in the FFA, and the number also increased significantly when the images of them were compared. Through follow-up, the white spots of the fundus could be dissipated after the disease healed and the abnormal fluorescence changes reviewed on FFA and ICGA could be fully restored by re-examinated 2 patients. Conclusions It is the characteristic change that the white spots show normal fluorescence during the early phase and hypofluorescence during the late phase on ICGA and the characteristic changes can be dissipated when the disease heals. It has the important significance to the MEWDS in the diagnosis, differential diagnosis and follow-up, which has the important value to judge the degree and the prognosis of the disease.