Multi-modality imaging on multiple evanescent white dot syndrome-A Spectralis Study

AIM: To present retinal microstructure, metabolism and function abnormalities in the course of multiple evanescent white dot syndrome (MEWDS) by Heidelberg spectralis modality imaging platform and observe its outcome by EDI-SD-OCT and two wavelength autofluorescence. METHODS: A case of multiple evanescent white dot syndrome in a 23-year-old female presented initially with a 15-day history of floaters and a central scotoma in the right eye. To establish the diagnosis, multimodality imaging was performed, namely, blue light-fundus autofluorescence (BL-FAF, excitation 488nm, emission >500nm), near-infrared fundus autofluorescence (NIR-FAF, excitation 787nm, emission >800nm) using a confocal scanning laser ophthalmoscope, fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), spectrum-domain enhance depth imaging optical coherence tomography (SD-EDI-OCT), multifocal eleclroretinography (mf-ERG) and fundus photogragh were performed and followed up at the eighth month after initially visiting. RESULTS: Optical coherence tomography (OCT) showed a transient disruption of the foveal photoreceptor outer segments in correspondence to foveal granularity. NIR-FAF showed hypoautofluorescent areas, <= 40 mu m in size, mostly concentrated around the posterior pole and its temporal side less than that in BL-FAF. Mf-ERG show pinnade disappeared in fovea and macula and responses decreased markedly compared with the follow eye. At the eighth month follow up, hyperfluorescence in BL-FAF were disappear, while, NIR-FAF Hypofluorescent spots in early stage of such lesion were reduced. But OCT demonstrated the structure was recovered in residual Hypofluorescent area in NIR-FAF. The subfoveal choroidal thickness was decreased from 372 mu m to 307 mu m slightly and cost line was recovered. CONCLUSION: MEWDS is a benign self-healing disease and there is no pathological evidence to investigate the natural course of such disease. SD-OCT allows highly detailed images approaching histopathology to certify the microstructural changes. Two-wave length FAF and mf-ERG provide more information about metabolism in outer retina especial RPE and photoreceptor. Spectralis OCT combined with two-wavelength FAF and mf-ERG provide a new way to analyze this disease and offer more details for therapy and follow-up.

Choroidal neovascularization as the initial manifestation of multiple evanescent white dot syndrome

To report the case of a patient who presented with idiopathic choroidal neovascularization(CNV)as the first sign of multiple evanescent white dot syndrome(MEWDS).A 25-year-old woman presented with recent onset of decreased vision and metamorphopsia in the right eye.The results of fundoscopic examination,fluorescein angiography,and optical coherence tomography(OCT) were compatible with a diagnosis of idiopathic CNV,which was treated with one intravitreal injection of bevacizumab.Five years later,the patient returned complaining of photopsia and decreased vision in the same eye.The fundoscopic examination showed typical signs of MEWDS.After 3 months,recurrence of CNV was observed in the same eye.In conclusion,idiopathic CNV might be the only manifestation of a subclinical occurrence of MEWDS.In this case,it was followed by a recurrence of MEWDS and subsequent reactivation of CNV.

多发性一过性白点综合征的临床观察

目的：探讨多发性一过性白点综合征（ｍｕｌｔｉｐｌｅｅｖａｎｅｓｃｅｎｔｗｈｉｔｅｄｏｔｓｙｎｄｒｏｍｅ，ＭＥＷＤＳ）的临床特点和病因。方法：对６例ＭＥＷＤＳ患者作视力、眼底、视野和电生理等检查并随诊４周～８个月。结果：急性期视力突然轻至中度下降，视网膜深层多发性白点，同时伴有轻度的视野和电生理改变。眼底荧光血管造影（ｆｕｎｄｕｓｆｌｕｏｒｅｓｃｅｉｎａｎｇｉｏｇｒｐｈｙ，ＦＦＡ）可见圆形或环形强荧光斑，晚期着染。可伴有视乳头强荧光和轻度血管渗漏。白点于４～１４周完全退行而不留痕迹。视力完全恢复。结论：ＭＥＷＤＳ为炎症性疾病，与多灶性脉络膜炎（ｍｕｌｔｉｆｏｃａｌｃｈｏｒｏｉｄｉｔｉｓ）可能有关。

急性区域性隐匿性外层视网膜病变的眼底光学影像学特征及意义

【摘要】目的观察急性区域性隐匿性外层视网膜病变（AZOOR）的眼底光学影像学特征，探讨眼底光学影像检查在AZOOR诊断及鉴别诊断中的临床作用。方法回顾性分析2008年1月至2014年9月期间经河北省眼科医院门诊检查后初诊为AZOOR的48例（48只眼）患者进行眼底光学影像学检查。包括频域光学相干断层扫描（FD—OCT）以及眼底自发荧光照相（FAF）、眼底荧光血管造影（FFA）、吲哚青绿血管造影（ICGA）。观察患者眼底后极部在各项检查中的改变特征；通过随诊，观察它们的预后转归；并对所有患眼的临床资料进行总结分析。结果眼科门诊初诊为I型AZOOR的48只患眼，经眼底光学影像学检查后，大致表现为两种类型。第一类28只眼，他们仅在FD—OCT检查中有异常改变，表现为眼底后极部光感受器内外节连接（IS／OS）层反光带紊乱，变薄、甚至局部缺失，伴RPE层光带紊乱，并与视野缺损区相对应，而在FAF、FFA、ICGA检查中无异常改变，属于Ⅰ型AZOOR。第二类20只眼，他们在FD—OCT中的改变与第一类相类似，但在FAF、FFA及ICGA检查中的表现却完全不同。其中在FAF检查中眼底后极部有强自发荧光灶分布；在FFA早期眼底对应部位可见轻微的斑点状强荧光，后期荧光增强；在ICGA早期眼底无异常改变，但后期眼底对应部位出现了明显的低荧光；且这些异常荧光灶在分布上与视野缺损区域均相对应，属于Ⅱ型AZOOR中的多发性一过性白点综合征（MEWDS）。结论Ⅰ型AZOOR与MEWDS具有类似的临床表现和FD—OCT表现，临床上容易混淆。但他们具有完全不同的FAF、FFA、ICGA改变特征。因此，熟练掌握它们各自在FAF、FFA及ICGA中的改变特征对于这两者的鉴别诊断具有重要意义。而FD—OCT检查由于具有简单、快捷、无创、分辨率高等特点，能够动态监测这些患者病变部位的感光细胞层内部结构的改变，非常适合于两者的随访观察。