IDIOPATHIC MULTIFOCAL WHITE DOT SYNDROMES

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IDIOPATHIC MULTIFOCAL WHITE DOT SYNDROMES
Dr George Papanikolaou SHO in Ophthalmology,
Dept of Ophthalmology, Singleton Hospital,
Swansea
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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

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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
• Creamy white placoid lesions at PP (RPE level)
• Mild vitritis/ vessel sheathing/ disc oedema
• FFA early dense hypofluorescence
• late staining
• Inactive window defect
• ICG Hypofluorescence (activehealed)
• Systemic microvasculopathy (Skin, kidney, CNS)
• Recovery within 1/12, depigmentation and
  clumping

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SERPIGENOUS CHOROIDOPATHY

• Bilateral, chronic/ recurring, progressive,
  40-60y, Poor prognosis
• VA uni? bilateral (asymmetric), Scotomata,
  Photopsiae
• Active Cream coloured,hazy borders, increasing
  brightness/ optic disc?centrifugaly/ May start
  ANYWHERE/ Skip- satellite lesions/ Border
  inactive scars (DD APMPPE)/ Vascular predilection
• Anterior uveitis/ vitritis
• 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

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BIRDSHOT CHORIORETINOPATHY/ BSR

• Bilateral, women, middle age, guarded prognosis
• Remissions- exacerbations
• HLA-A29 ( HIGHEST RR of any disease200x)
• A29.2/ S-antigen/ CD8/ Choroid ret. vessels
• Floaters, ?VA- nyctalopia- photopsia- ? colour
  vision
• Creamy yellow ovoid deep spots/ centrifugal/
  nasal-inferior retina
• Vitritis/ vasculitis/ narrowing of vessels
• CMO/ disc oedema
• 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

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PUNCTATE INNER CHOROIDOPATHY PIC

• Bilateral, young myopic women, guarded prognosis
• Scotomata/ photopsia/ Blurred vision
• Small spots (same age),PP/ same as MCP
• SRD
• NO uveitis/vitritis
• DD from POHS
• Weeks to recover
• Residual scars (with ? pigment)
• CNVM

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MULTIFOCAL CHOROIDITIS WITH PANUVEITIS MCP

• Uni? bi, myopic, women, middle age, fair
  prognosis
• Subacute blurring/ photopsiea/ scotomata/
  floaters/ photophobia/ pain
• Multiple, deep, yellow-grey lesions
• Vitritis (all)/ ant. uveitis 50 (DD POHS)
• Chronic atrophypigmentation
• FFA early hypo-
• late fuzzy leaking
• ICG hypofl. spots- peripapillary
• Recurrences (common)
• CMO, Subretinal Fibrosis, CNVM
• Rx Steroids/ Imunosuppressants/ Laser

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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-B7?Maculopathy
• Histo spots (PP, midperiphery)/ linear
  streaks-equator
• PPA
• CNVM (?v if macular spots)
• Clear Vitreous, No PED
• Positive skin testing/ serology/ CXR
• Laser/ Surgical

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