Multiple Transient White Spot Syndrome

Introduction to multiple transient white spot syndrome Multipleevanescent white dotsyndrome (MEWDS) was first reported by Jampol et al in 1984. It is a rare, unexplained, multiple white spotted lesion located deep in the retina or retinlpigmentepithelium (RPE), usually monocular. basic knowledge The proportion of the disease: 0.08% - 0.09% Susceptible people: no specific people Mode of infection: non-infectious Complications: subretinal neovascular membrane

The etiology of multiple transient white spot syndrome

(1) Causes of the disease

May be associated with viral infections and autoimmune diseases.

(two) pathogenesis

The pathogenesis of this disease is still not fully understood. Some people think that the infection factor may be related to its pathogenesis. Some people think that infection may be an inducement, which causes the damage caused by tissue damage, antigen exposure, new antigen formation and immune dysfunction. The autoimmune reaction causes diseases such as multiple easily dissipative white spot syndrome.

Multiple transient white spot syndrome prevention

Pay attention to rest, work and rest, life in an orderly manner, and maintaining an optimistic, positive and upward attitude towards life can be of great help in preventing diseases.

Multiple transient white spot syndrome complications Complications, subretinal neovascular membrane

Complications of this disease are rare, occasionally causing subretinal neovascular membrane (the macular fovea neovascular membrane), acute macula, neuroretinopathy and so on.

Symptoms of multiple transient white point syndrome Common symptoms Blind spot visual impairment Physiological blind spot enlarges visual field of vision changes center dark spot or bow dark spot

Most patients complained of sudden loss of vision and flashing sensation. Some patients may have dark spots of visual field. The range of visual acuity may range from 1.0 to 0.05, but most of them are mild, moderately decreased. The anterior segment examination is normal. Many white spots are seen in the fundus examination. The lesion, located in the deep layer of the retina and RPE, is mostly distributed in the posterior pole and the macula near the vascular arch, but does not invade the fovea. The lesions near the equator are sparse and sparse. Typical lesions are approximately circular and vary in size. It is 100-500m, with light color and blurred borders. It is like the photo-condensation of low-power laser on the retina. Fine pigment particles are often seen in the fovea. In some cases, the disc boundary is unclear. In the acute phase, there are a few cells in the vitreous. In a few cases, vascular white sheath formation is seen.

In the early stage of fundus fluorescein angiography, clustered strong fluorescent spots corresponding to white spot lesions can be seen. In the later stage, fluorescein staining and optic disc capillary leakage can be seen. The early stage of indocyanine green angiography does not show choroidal vascular abnormalities, but After 10 minutes, there was no dark spots in the late stage of the angiography, and the lesions were not easily detected under the ophthalmoscope and fluorescein angiography. At this time, the diameter of the non-fluorescent spots was larger than that of the other lesions seen at other examinations. The weak fluorescent region surrounds.

Visual field examination can be changed in a variety of forms, and the development of physiological blind spots is the most common, especially in the case of ICG angiography, where there is a ring-shaped weak fluorescence of the optic disc. In addition, a bow-shaped dark spot, a side-center dark spot or a central dark spot can be seen, and electrophysiological examination shows ERG. The amplitude of the a wave and the early reaction potential decreased, and the level 1 retinal function of the multifocal ERG showed focal abnormalities in the early stage of the disease, and the EOG test results were also abnormal.

Most patients with MEWDS have a relatively short course of disease. The white lesions in the fundus often disappear within 1 to 2 weeks. The abnormalities of fluorescein angiography and electrophysiology can be quickly restored. The visual acuity is restored to the pre-morbid level within 3 to 10 weeks. However, the physiological blind spot enlargement of the visual field and the non-fluorescent dark spot seen by ICG angiography can remain for a relatively long period of time. After the MEWDS is cured, there is no scar on the fundus, and only the slight residual RPE pigment changes in the macula, fluorescein angiography Occasionally, the window is missing.

Examination of multiple transient white spot syndrome

Circulating immune complexes, IgG, IgM, IgA, ANA, etc. can be used to check the immune status of patients, and HLA-B51 examination has reference value for the diagnosis of the disease.

1. Fluorescein fundus angiography and indocyanine green angiography: white spots in the acute phase of the disease can be found, with strong plaque-like fluorescence or point-like strong fluorescence, and point-like strong fluorescence often arranged in a flower ring, late retina Pigment epithelium and optic disc staining, occasionally see optic disc and retinal capillary leakage, a small number of patients with window-like retinal pigment epithelial loss and window-like defects, disease activity, indocyanine green angiography in the movement, no change in the venous phase It suggests that the choroidal large vessels are not affected; about 10 minutes, there are multiple small round weak fluorescent spots in the posterior to the middle part. The number of lesions found is much larger than the number of lesions found by fluorescein fundus angiography, indicating that the disease is not only Involving the retinal pigment epithelium and photoreceptors may involve choroidal capillaries or anterior capillaries; when the lesions tend to subside or have subsided, the weak fluorescent spots shown by angiography become smaller or disappear.

2. Visual field examination: It can be found that the physiological blind spot is enlarged, the central dark spot or the arcuate dark spot, and sometimes the visual field defect range is large, which is inconsistent with the lesion found under the ophthalmoscope.

3. Electrophysiological examination: In the acute phase of the disease, the electroretinogram, the early sensor potential is usually significantly reduced, and the early receptor potential regeneration time is prolonged. These changes suggest that the lesion is located at the photoreceptor-retinal pigment epithelium-Bruch membrane complex level, such as The patient has swollen optic disc, which can cause a decrease in the amplitude of the electro-oculogram and an increase in the latency.

Diagnosis and diagnosis of multiple transient white spot syndrome

diagnosis

The diagnosis of this disease is mainly based on its typical fundus manifestations, clinical data such as natural regression of the lesions, fluorescein fundus angiography and indocyanine green angiography are helpful for diagnosis, especially for clinical atypical or disease recurrence. More diagnostic value, visual field examination and electrophysiological examination can provide certain information for diagnosis.

Differential diagnosis

1. Acute posterior multifocal squamous pigment epithelial lesions (APMPPE): more common in young patients, clinically have rapid recovery after a brief decline in vision, RPE squamous lesions appearing in the fundus can also subside, accompanied by optic disc Inflammation and vitreous inflammatory manifestations, but APMPPE mostly in the eyes of both eyes, the lesions are larger and deeper, the color is yellower and more intense, fluorescein angiography is used to mask fluorescence in the early stage and strong fluorescence in the later stage.

2. Multifocal choroiditis with total uveitis: is an RPE-choroidal inflammatory disease, also seen in healthy myopia women, often accompanied by more obvious inflammation of the anterior chamber and vitreous, the lesions are usually thicker and can be scattered In the peripheral part, after the inflammation subsided, the lesion appeared as atrophy with pigment, and the visual recovery was slow. The cystoid edema and choroidal neovascular membrane often appeared, and the multifocal ERG examination showed persistent diffuse damage.

3. Shotgun-like retinal choroiditis: a lesion that occurs in RPE or deeper multiple cream-like lesions, often accompanied by more obvious vitreous inflammatory cell infiltration, more common in the elderly and bilateral eyes, fluorescein angiography The lesions were often less visible than indirect ophthalmoscopes, and the early lesions were obscured by fluorescence, and later were slightly strong fluorescence.

4. Acute retinal pigment epithelitis: the same as young patients, the course of disease is similar to MEWDS, but the typical lesion is a dark pigmented spot surrounded by a depigmented halo, fluorescein angiography is weak Fluorescent spots are surrounded by a strong fluorescent ring.

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