多发性一过性白点综合征的临床特征分析及治疗选择

Clinical characteristics and the treatment choice of multiple evanescent white dot syndrome

目的观察多发性一过性白点综合征(MEWDS)的临床表现及疗效。方法回顾分析我院2012年1月~2017年12月确诊的8例MEWDS患者的临床资料,对其发病年龄、起病方式、眼底表现、视野、电生理、各种影像学检查结果、并发症以及转归进行回顾性分析。结果 8例患者均为既往体健的青年患者,急性起病,大部分伴轻、中度近视,眼底、自发荧光、荧光素眼底血管造影(FFA)、吲哚菁绿血管造影(ICGA)、光学相干层析成像(OCT)及眼电图(EOG)均具有特征性。大部分未经任何治疗,主诉症状均在1~4周内完全消失,视力逐步提高。眼底白色斑点及自发荧光强荧光斑1周后复查均有不同程度的消退,6~8周基本消退殆尽;ICGA检查斑片状弱荧光斑消退时间相对延迟,10~12周完全消退。1例患者并发脉络膜新生血管(CNV),抗血管内皮生长因子(VEGF)治疗后视力预后好。结论 MEWDS是一种自限性疾病,对于病情较轻,FFA检查视盘无明显荧光渗漏的患者,可随访观察;当视力下降明显、视野损害较重,且排除了其他原发性视神经病变的情况下,可酌情短期口服小剂量糖皮质激素。该病并发症少见,少数可并发CNV,给予相应抗炎及抗VEGF治疗后,视力预后均较好。

Objective To observe the clinical characteristics and curative effect of multiple evanescent white clot syndrome （MEWDS）. Methods Data of 8 cases of MEWDS diagnosed from 01/2012 to 12/2017 were retrospectively analyzed. The age of onset, onset mode, fundus manifestations, visual field, electrophysiology, all kinds of imaging findings, complications and outcomes were retrospectively analyzed. Results Eight patients who were healthy young patients were all acute onset, most of them with mild to moderate myopia, 2 cases with high myopia, autofluorescence, fundus fluorescein angiography （FFA）, indocyanine green angiography （ICGA）, optical coherence tomography （OCT） and electrooculogram （EOG） were characterized. Most of them accepted no treatment and the symptoms were all disappeared within 1 week to 4 weeks. Visual acuity gradually improved. White spots in fundus and strong spontaneous fluorescent spot in fundus autofluorescence regressed at different degrees 1 week later, and disappeared completely 6 to 8 weeks later. The extinction time of weak fluorescence spots in ICGA were relatively delayed and completely reduced at 10 to 12 weeks. One patient complicated with choroidal neovascularization （CNV） accepted a good prognosis after mlti- vascular endothelial growth factor （VEFG） therapy-. Conclusions MEWDS is a self-limited disease. The patients who have no obvious fluorescent leakage in the optic disc could be followed up. When the visual loss was obvious, the visual field damage was serious, and the primary optic neuropathy were excluded, small close of steroid could be taken orally for a short time. The complications of the disease were rare and a few of them could complicate with CNV. After the treatment of anti-inflammation and anti-VEGF, the prognosis of visual acuity was better.