Ophthalmology Department, Hospital Clínico San Carlos, Madrid, Spain.
Rheumatology Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.
Graefes Arch Clin Exp Ophthalmol. 2019 Nov;257(11):2505-2516. doi: 10.1007/s00417-019-04429-5. Epub 2019 Aug 5.
To compare the clinical prognosis among selected white dot syndromes (WDS) (birdshot chorioretinopathy (BRC), multifocal choroiditis, serpiginous choroidopathy (SC), and others) and to identify risk factors of poor visual prognosis.
Retrospective longitudinal cohort study including 84 patients (143 affected eyes) diagnosed with WDS between 1982 and July 2017, followed up until loss of follow-up or December 2017, and recruited from three Uveitis Clinics (Madrid Community, Spain). Our main outcome measures were temporary or permanent moderate (corrected visual acuity in the Snellen scale < 20/50) or severe (< 20/200) vision losses, and development of new ocular complications. Incidence rates (IR) of the main outcome measures were estimated per 100 eye-years. Bivariate and multivariate Cox robust regression models analyzed the association of demographic- and clinical-related variables with vision loss.
SC exhibited the greatest IR of vision loss, even in the multivariate models. Previous events of vision loss, presence of choroidal neovascularization, and cataracts exhibited worse visual prognosis. Monotherapy with immunosuppressive drugs but not combine therapy was also associated with higher IR of visual loss. Regarding new ocular complications, BRC showed the highest IR of epiretinal membrane and macular edema.
SC presents the worst visual prognosis. Some ocular manifestations can identify patients with WDS at risk of a worse clinical evolution.
比较几种典型的白点综合征（WDS）（鸟枪弹样脉络膜视网膜病变（BCRC）、多发性脉络膜炎、匐行性脉络膜病变（SC）和其他病变）的临床预后，并确定影响不良视觉预后的相关因素。
回顾性纵向队列研究纳入了 1982 年至 2017 年 7 月期间在西班牙马德里社区三家葡萄膜炎诊所确诊为 WDS 的 84 名患者（143 只患眼），随访至失访或 2017 年 12 月。主要观察指标是暂时或永久性中度视力丧失（标准视力表视力<20/50）或重度视力丧失（<20/200），以及新出现眼部并发症。主要观察指标的发生率（IR）按每 100 眼年计算。单变量和多变量 Cox 比例风险回归模型分析了与视力丧失相关的人口统计学和临床相关变量的相关性。
SC 视力丧失的发生率最高，即使在多变量模型中也是如此。先前发生过视力丧失、脉络膜新生血管形成和白内障与较差的视力预后相关。免疫抑制药物单药治疗而非联合治疗与更高的视力丧失发生率相关。关于新的眼部并发症，BCRC 表现出最高的视网膜前膜和黄斑水肿发生率。
SC 表现出最差的视力预后。一些眼部表现可以识别出 WDS 患者存在更差的临床转归风险。
