Papadia Marina, Herbort Carl P
Centre for Specialized Ophthalmic Care (COS), University of Genova, Genova, Italy.
Middle East Afr J Ophthalmol. 2010 Jul;17(3):270-4. doi: 10.4103/0974-9233.65490.
We report a case of multiple evanescent white dot syndrome (MEWDS) that presented with putative idiopathic choroidal neovascularisation (ICNV) before showing angiographic signs typical of MEWDS. A 16-year-old male presented with unilateral metamorphopsias and visual loss in his left eye. ICNV with subretinal hemorrhage was diagnosed and treated with intravitreal Avastin(®). Fifteen days later, regression of choriodal neovascularization (CNV) was documented together with the appearance of fluorescein angiography (FA) and indocyanine green angiography (ICGA) signs typical for MEWDS, that included faint mottled FA hyperfluorescence in the mid-peripheral fundus, irregularly shaped mid-peripheral ICGA dark areas in the intermediate angiographic phase that were clearly delineated in the late phase as well as peripapillary hypofluorescence. Fundus examination appeared completely normal during the follow-up except for the CNV hemorrhage noted at the initial visit. This case demonstrates the need to consider ICNV as a diagnosis of exclusion until inflammatory causes have been eliminated. In this case, the underlying occult inflammatory condition would have been missed without the ICGA data that clearly showed signs of MEWDS that was supported by FA findings.
我们报告一例多发性一过性白点综合征（MEWDS），该病例在出现MEWDS典型血管造影征象之前表现为疑似特发性脉络膜新生血管（ICNV）。一名16岁男性因左眼单眼视物变形和视力丧失就诊。诊断为伴有视网膜下出血的ICNV，并接受玻璃体内注射阿瓦斯汀（Avastin®）治疗。15天后，记录到脉络膜新生血管（CNV）消退，同时出现了MEWDS典型的荧光素血管造影（FA）和吲哚菁绿血管造影（ICGA）征象，包括周边眼底微弱的斑点状FA高荧光、血管造影中期周边部不规则形状的ICGA暗区，在晚期清晰可见，以及视乳头周围低荧光。随访期间，除初诊时发现的CNV出血外，眼底检查完全正常。该病例表明，在排除炎症原因之前，需要将ICNV作为排除性诊断考虑。在本病例中，如果没有ICGA数据明确显示MEWDS征象并得到FA结果支持，潜在的隐匿性炎症情况就会被漏诊。
