多发性一过性白点综合征和多发性一过性白点综合征样改变

Multiple evanescent white dot syndrome and multiple evanescent white dot syndrome-like change

多发性一过性白点综合征(MEWDS)是一种单眼多见、以眼底多灶性白点为特征的急性视网膜疾病,病变主要侵犯视网膜色素上皮层以及外层视网膜。其典型临床表现包括:眼底边界清晰的灰白色斑点;荧光素眼底血管造影早期可见与斑点一致的强荧光;吲哚青绿血管造影晚期可见点片状弱荧光;眼底显示强自身荧光;病灶对应处光相干断层扫描显示椭圆体带中断、不连续甚至消失。近年来随着多模式影像技术的快速发展,有学者发现上述的这些影像学表现并非MEWDS所独有,临床上部分脉络膜视网膜疾病也可出现MEWDS样改变,这些疾病的实际病因可能是炎症、感染、免疫性或肿瘤相关性等,因伪装成MEWDS容易被误诊。因此,总结分析MEWDS的临床表现、影像学特征,同时对伪装成MEWDS的相关眼底病变的鉴别诊断进行分析,具有重要的临床意义。

Multiple evanescent white dot syndrome(MEWDS)is an acute retinal disease characterized by multifocal white spots in the fundus often seen in the unilateral eye.The lesions mainly involve the retinal pigment epithelium and the outer retinal structure.Typical ocular manifestations of MEWDS include grayishwhite outer retinal spots with a clear borderline identified on the fundus,findings of hyper-autofluorescence in the early stage consistent with the spots identified on the fundus,and the optical coherence tomography manifestation of multifocal disruption of the ellipsoid zone.With the rapid development of multimodal imaging technology,some scholars found that these manifestations are not exclusive to MEWDS as some types of chorioretinopathy can also show MEWDS-like changes.The etiology of these diseases may be inflammation,infection,immunity,or tumor-related,misdiagnosed by masquerading as MEWDS.Here we summarized the clinical manifestations and imaging features of MEWDS and reviewed the fundus lesions changes that can be misdiagnosed as MEWDS.