Ramakrishnan Meera S, Patel Amar P, Melles Ronald, Vora Robin A
Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania.
Kaiser Permanente Northern California, Oakland, California.
Ophthalmol Retina. 2021 Sep;5(9):850-854. doi: 10.1016/j.oret.2020.11.016. Epub 2020 Nov 30.
To report the clinical and imaging characteristics of multiple evanescent white dot syndrome (MEWDS) from a large single-center cohort.
Single-center, retrospective cohort study.
A total of 111 patients previously diagnosed with MEWDS in the Kaiser Permanente Northern California system from 2012 to 2019.
Two retina specialists reviewed the medical records and all available retinal imaging, including Humphrey visual field testing, fundus photography (FP), OCT, fluorescein angiogram (FA), and fundus autofluorescence (FAF). Patients were excluded from analysis if confirmatory imaging was unavailable.
Patient characteristics, visual acuity, clinical examination and imaging findings, and final diagnosis.
Seventy-three patients (65.8%) were confirmed to have the diagnosis of MEWDS. Fifty-eight (79.5%) were female, with a mean (standard deviation [SD]) age at presentation of 35.2 (14.2) years, and mean refractive error of -1.6 diopters. Initial mean (SD) visual acuity was logarithm of the minimum angle of resolution (logMAR) 0.39 (0.31) and improved to mean (SD) logMAR 0.07 (0.15) at final follow-up. Presenting symptoms included blurred vision (82%), scotomas (56%), photopsias (43%), and floaters (23%). Nine patients (12%) had a previously diagnosed autoimmune condition, and 2 patients (3%) had documentation of a recent vaccination. Antecedent upper respiratory infection was documented in 15 of 66 patients (23%). Noted clinical and imaging features include ellipsoid zone disruption (100%), white fundus lesions (92%), FA hyperfluorescence (92%), foveal granularity (74%), vitreous cell (53%), and optic disc edema (52%). Twenty-nine of the 111 patients (26%) were initially misdiagnosed with MEWDS and subsequently given an alternative diagnosis, including other white dot syndromes, syphilis, primary vitreoretinal lymphoma, myopic degeneration, and central serous chorioretinopathy.
Multiple evanescent white dot syndrome is a rare self-limiting condition of the outer retina. Although a distinct set of clinical exam and imaging findings permit recognition of this disease, misdiagnosis is not uncommon.
报告来自一个大型单中心队列的多发性一过性白点综合征（MEWDS）的临床和影像学特征。
单中心回顾性队列研究。
2012年至2019年期间在北加利福尼亚凯撒医疗系统中先前被诊断为MEWDS的111例患者。
两位视网膜专家查阅了病历以及所有可用的视网膜影像资料，包括汉弗莱视野检查、眼底照相（FP）、光学相干断层扫描（OCT）、荧光素血管造影（FA）和眼底自发荧光（FAF）。如果无法获得确诊影像，则将患者排除在分析之外。
患者特征、视力、临床检查和影像检查结果以及最终诊断。
73例患者（65.8%）被确诊为MEWDS。58例（79.5%）为女性，就诊时的平均（标准差[SD]）年龄为35.2（14.2）岁，平均屈光不正为-1.6屈光度。初始平均（SD）视力为最小分辨角对数（logMAR）0.39（0.31），在最终随访时提高到平均（SD）logMAR 0.07（0.15）。出现的症状包括视力模糊（82%）、暗点（56%）、闪光感（43%）和飞蚊症（23%）。9例患者（12%）先前被诊断患有自身免疫性疾病，2例患者（3%）有近期接种疫苗的记录。66例患者中有15例（23%）记录有前驱上呼吸道感染。观察到的临床和影像学特征包括椭圆体带破坏（100%）、眼底白色病变（92%）、FA荧光增强（92%）、黄斑颗粒状改变（74%）、玻璃体细胞（53%）和视盘水肿（52%）。111例患者中有29例（26%）最初被误诊为MEWDS，随后被给予其他诊断，包括其他白点综合征、梅毒、原发性玻璃体视网膜淋巴瘤、近视性变性和中心性浆液性脉络膜视网膜病变。
多发性一过性白点综合征是一种罕见的外层视网膜自限性疾病。尽管一组独特的临床检查和影像学表现有助于识别这种疾病，但误诊并不罕见。
