PDF(Pubmed)
Abstract：
UNASSIGNED: To report a case of secondary Multiple Evanescent White Dot Syndrome in a patient with preexisting wet age-related macular degeneration.
UNASSIGNED: A 75-year-old male on treat and extend regimen for wet age-related macular degeneration (AMD) presented with a sudden loss of vision and saw central dark shadow in the right eye (RE) for a duration of 1 week. There was no significant history preceding the visual loss. Examination showed a visual acuity (VA) of counting fingers at 1 meter in the right eye and 20/25 in the left eye. Anterior segment examination was unremarkable with dilated fundus examination showing a clear vitreous, tortuous blood vessel, a hyperemic disc and fibrosis at the macula. The left eye (LE) examination was unremarkable. Optical Coherence Tomography (OCT) showed fibrosis due to the previous wet AMD and hyperreflective excrescences projecting from the retinal pigment epithelium (RPE) outside of the old area of wet AMD. Fundus Fluorescein Angiogram (FFA) showed hyperfluorescent spots in a wreath-like pattern increasing in intensity in the early phase and showing late staining towards the late phase while Indocyanine green angiography (ICGA) did not clearly delineate the lesions. Fundus autofluorescence (FAF) revealed hyper Autofluorescence (AF) at the posterior pole. Optical Coherence Tomography Angiography (OCTA) revealed a flow reduction in the choriocapillaris of the affected area. Basic blood investigations with Venereal Disease Research Laboratory (VDRL), syphilitic IgM and IgG antibodies, Quantiferon TB gold test, complete renal function tests and liver function tests were performed. All the blood investigations were within normal limits and the workup for syphilis and tuberculosis was negative. The patient was started on 1mg/kg body weight of oral prednisolone (after the non-response to low dose of oral steroids) with the diagnosis of secondary multiple evanescent white dot syndrome (MEWDS) secondary to wet AMD. The patient was followed up every weekly and the last visit showed improvement in visual acuity to 20/50 with resolution of lesions on FAF and OCT macula.
UNASSIGNED: Secondary MEWDS is extremely rare and unique in terms of its presentation and its association with preexisting chorioretinal disease where there is damage to the choriocapillaris- Bruch\'s membrane-RPE complex. This case report highlights one such rare case scenario and how multimodal imaging helps in the diagnosis, management and follow-up of patients with secondary MEWDS.
UNASSIGNED: A 75-year-old male on treat and extend regimen for wet age-related macular degeneration (AMD) presented with a sudden loss of vision and saw central dark shadow in the right eye (RE) for a duration of 1 week. There was no significant history preceding the visual loss. Examination showed a visual acuity (VA) of counting fingers at 1 meter in the right eye and 20/25 in the left eye. Anterior segment examination was unremarkable with dilated fundus examination showing a clear vitreous, tortuous blood vessel, a hyperemic disc and fibrosis at the macula. The left eye (LE) examination was unremarkable. Optical Coherence Tomography (OCT) showed fibrosis due to the previous wet AMD and hyperreflective excrescences projecting from the retinal pigment epithelium (RPE) outside of the old area of wet AMD. Fundus Fluorescein Angiogram (FFA) showed hyperfluorescent spots in a wreath-like pattern increasing in intensity in the early phase and showing late staining towards the late phase while Indocyanine green angiography (ICGA) did not clearly delineate the lesions. Fundus autofluorescence (FAF) revealed hyper Autofluorescence (AF) at the posterior pole. Optical Coherence Tomography Angiography (OCTA) revealed a flow reduction in the choriocapillaris of the affected area. Basic blood investigations with Venereal Disease Research Laboratory (VDRL), syphilitic IgM and IgG antibodies, Quantiferon TB gold test, complete renal function tests and liver function tests were performed. All the blood investigations were within normal limits and the workup for syphilis and tuberculosis was negative. The patient was started on 1mg/kg body weight of oral prednisolone (after the non-response to low dose of oral steroids) with the diagnosis of secondary multiple evanescent white dot syndrome (MEWDS) secondary to wet AMD. The patient was followed up every weekly and the last visit showed improvement in visual acuity to 20/50 with resolution of lesions on FAF and OCT macula.
UNASSIGNED: Secondary MEWDS is extremely rare and unique in terms of its presentation and its association with preexisting chorioretinal disease where there is damage to the choriocapillaris- Bruch\'s membrane-RPE complex. This case report highlights one such rare case scenario and how multimodal imaging helps in the diagnosis, management and follow-up of patients with secondary MEWDS.
摘要：
■报告一例先前存在湿性年龄相关性黄斑变性的继发性多发性白点消失综合征。
■一名75岁男性正在接受湿性年龄相关性黄斑变性（AMD）的治疗和扩展方案，表现为视力突然丧失，右眼（RE）出现中央黑影，持续1周。视力丧失之前没有明显的病史。检查显示在右眼1米处和左眼20/25处计数手指的视敏度(VA)。前节检查不明显，眼底扩张检查显示玻璃体清晰，曲折的血管，椎间盘充血和黄斑纤维化。左眼(LE)检查无异常。光学相干断层扫描（OCT）显示出纤维化，这是由于先前的湿性AMD和从湿性AMD旧区域外部的视网膜色素上皮（RPE）投射的超反射异常所致。眼底荧光素血管造影（FFA）显示出高荧光斑点，呈花环状，在早期强度增加，并在后期显示晚期染色，而吲哚菁绿血管造影（ICGA）并未清楚地描绘病变。眼底自发荧光（FAF）显示后极高度自发荧光（AF）。光学相干断层扫描血管造影（OCTA）显示受影响区域的脉络膜毛细血管流量减少。性病研究实验室（VDRL）的基础血液调查，梅毒IgM和IgG抗体，QuantiferonTB金测试，进行了完整的肾功能检查和肝功能检查.所有血液检查均在正常范围内，梅毒和结核病检查均为阴性。患者开始服用1mg/kg体重的口服泼尼松龙（对低剂量口服类固醇无反应后），诊断为继发于湿性AMD的继发性多发性渐逝白点综合征（MEWDS）。每周对患者进行随访，最后一次就诊显示视力改善至20/50，FAF和OCT黄斑上的病变消退。
■继发性MEWDS在其表现及其与先前存在的脉络膜视网膜疾病的关联方面极为罕见且独特，其中脉络膜-布鲁赫膜-RPE复合物受损。本病例报告重点介绍了一种罕见病例，以及多模态成像如何帮助诊断。继发性MEWDS患者的管理和随访。
■一名75岁男性正在接受湿性年龄相关性黄斑变性（AMD）的治疗和扩展方案，表现为视力突然丧失，右眼（RE）出现中央黑影，持续1周。视力丧失之前没有明显的病史。检查显示在右眼1米处和左眼20/25处计数手指的视敏度(VA)。前节检查不明显，眼底扩张检查显示玻璃体清晰，曲折的血管，椎间盘充血和黄斑纤维化。左眼(LE)检查无异常。光学相干断层扫描（OCT）显示出纤维化，这是由于先前的湿性AMD和从湿性AMD旧区域外部的视网膜色素上皮（RPE）投射的超反射异常所致。眼底荧光素血管造影（FFA）显示出高荧光斑点，呈花环状，在早期强度增加，并在后期显示晚期染色，而吲哚菁绿血管造影（ICGA）并未清楚地描绘病变。眼底自发荧光（FAF）显示后极高度自发荧光（AF）。光学相干断层扫描血管造影（OCTA）显示受影响区域的脉络膜毛细血管流量减少。性病研究实验室（VDRL）的基础血液调查，梅毒IgM和IgG抗体，QuantiferonTB金测试，进行了完整的肾功能检查和肝功能检查.所有血液检查均在正常范围内，梅毒和结核病检查均为阴性。患者开始服用1mg/kg体重的口服泼尼松龙（对低剂量口服类固醇无反应后），诊断为继发于湿性AMD的继发性多发性渐逝白点综合征（MEWDS）。每周对患者进行随访，最后一次就诊显示视力改善至20/50，FAF和OCT黄斑上的病变消退。
■继发性MEWDS在其表现及其与先前存在的脉络膜视网膜疾病的关联方面极为罕见且独特，其中脉络膜-布鲁赫膜-RPE复合物受损。本病例报告重点介绍了一种罕见病例，以及多模态成像如何帮助诊断。继发性MEWDS患者的管理和随访。
