Transcript Document
IDIOPATHIC MULTIFOCAL WHITE DOT SYNDROMES Dr George Papanikolaou SHO in Ophthalmology, Dept of Ophthalmology, Singleton Hospital, Swansea MULTIPLE EVANESCENT WHITE DOT SYNDROME MEWDS Unilateral, Young myopic women, idiopathic, Excellent prognosis Acute unilateral VA, photopsia, scotomata/ Viral prodrome •Numerous migratory white dots (faint, PP, mid-periphery) •Foveal granularity- Pathognomonic- PERSISTENT •Mild papillitis/ vitritis/ disc oedema/ vasculitis FFA: early punctate hyperfluorescence/ late: staining ICG: typical multiple hypofluorescent spots throughout fundus Hypofluorescence around optic nerve VF: BS, disproportionate to clinical findings/ PERSISTENT Recovery: 3-10/52, , no scarring ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY/ APMPPE Bilateral, young healthy adults, good prognosis HLA-B7 ,DR2 / Influenza-like prodrome 50% VA uni- bilateral in a few days 1. Creamy white placoid lesions at PP (RPE level) 2. Mild vitritis/ vessel sheathing/ disc oedema FFA: early: dense hypofluorescence late: staining Inactive: window defect ICG: Hypofluorescence (active+healed) Systemic microvasculopathy (Skin, kidney, CNS) Recovery: within 1/12, depigmentation and clumping SERPIGENOUS CHOROIDOPATHY Bilateral, chronic/ recurring, progressive, 40-60y, Poor prognosis VA uni bilateral (asymmetric), Scotomata, Photopsiae 1. Active: Cream coloured,hazy borders, increasing brightness/ optic disccentrifugaly/ May start ANYWHERE/ Skipsatellite lesions/ Border inactive scars (DD APMPPE)/ Vascular predilection 2. Anterior uveitis/ vitritis 3. Inactive: choroidal atrophy (large chor. vessels) FFA: early: central hypo+ hyper rim late: hyper leaks into the lesion (spotty staining) Healed: visible large choroidal vessels CNVM No systemic associations Rx: steroids, azathioprine, cyclosporine/ laser BIRDSHOT CHORIORETINOPATHY/ BSR Bilateral, women, middle age, guarded prognosis Remissions- exacerbations HLA-A29 ( HIGHEST RR of any disease~200x) A29.2/ S-antigen/ CD8+/ Choroid + ret. vessels Floaters, VA- nyctalopia- photopsia- colour vision 1. Creamy –yellow ovoid deep spots/ centrifugal/ nasalinferior retina 2. Vitritis/ vasculitis/ narrowing of vessels 3. CMO/ disc oedema 4. Chronic: well defined atrophy/ NO PIGMENT FFA: early: normal/ ‘Quenching’ of vessels late: leakage (intraretinal, disc) ICG: hypo-, fuzzy choroidal vessels: Activity Rx: steroids/ immunosuppressants PUNCTATE INNER CHOROIDOPATHY PIC Bilateral, young myopic women, guarded prognosis Scotomata/ photopsia/ Blurred vision 1. Small spots (same age),PP/ same as MCP 2. SRD 3. NO uveitis/vitritis DD from POHS Weeks to recover Residual scars (with pigment) CNVM MULTIFOCAL CHOROIDITIS WITH PANUVEITIS MCP Uni bi, myopic, women, middle age, fair prognosis Subacute blurring/ photopsiea/ scotomata/ floaters/ photophobia/ pain 1. Multiple, deep, yellow-grey lesions 2. Vitritis (all)/ ant. uveitis 50% (DD POHS) 3. Chronic: atrophy+pigmentation FFA: early: hypolate: fuzzy leaking ICG: hypofl. spots- peripapillary Recurrences (common) CMO, Subretinal Fibrosis, CNVM Rx: Steroids/ Imunosuppressants/ Laser PRESUMED OCULAR HISTOPLASMOSIS SYNDROME POHS H. capsulatum/ Missisipi- Ohio 30-40y Good prognosis/ 2-10% ocular lesions in endemic areas 1/1000 maculopathy HLA DR2, HLA-B7Maculopathy 1. Histo spots (PP, midperiphery)/ linear streaks-equator 2. PPA 3. CNVM (v if macular spots) 4. Clear Vitreous, No PED Positive skin testing/ serology/ CXR Laser/ Surgical