多发性一过性白点综合征的临床表现及治疗  

The optical imaging features and clinical significances of the multiple evanescent white dot syndrome

作　　者：周才喜[1] 苑志峰[1] 王浩[1] 刘志强[1] 杨荣[1] 

机构地区：[1]河北省邢台市眼科医院激光造影室,河北054001

出　　处：《中国实用眼科杂志》2011年第11期1189-1193,共5页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨多发性一过性白点综合征（MEWDS）的临床表现及治疗。方法回顾性分析2009年1月至2010年12月确诊的8例MEWDS病例的临床资料，总结其临床特征。结果8例MEWDS患者均为单眼发病，其中男性3例，女性5例。平均年龄为33岁（19～48岁）。就诊时平均发病时间为6．5d（2～12d）。初诊时平均矫正视力为0．54（0．15—0．8）。所有患眼玻璃体内均有炎症细胞。眼底检查所有患眼视网膜深层均可见多个灰白色网形斑点状病灶，直径约50～500μm，边界欠清晰，表面无隆起。有3例（37．5％）还伴随视乳头充血。FFA早期所有患眼白点状病灶对应部位呈圆形强荧光斑，晚期呈强荧光染色；4只眼（50％）出现视乳头强荧光，3只眼（37．5％）伴随视网膜血管节段性渗漏。ICGA早期所有患眼均基本正常；而晚期所有患眼（100％）眼底后极部均可见大量边界清晰的斑点状低荧光灶散在或密集分布，与脉络膜毛细血管呈小叶状分布的解剖特征相符。OCT检查发现白点状病灶部位视细胞内节／外节（IS／OS）层反光带紊乱，部分完全消失。经小剂量糖皮质激素治疗，2-3月后所有患眼均完全痊愈。结论MEWDS属于脉络膜毛细血管层炎症性病变，发病较快，视功能中度受损，预后好。FFA及ICGA检查对MEWDS的诊断和鉴别诊断有重要价值，而OCT检查对病情的随访观察有重要意义。Objective To explore the clinical manifestations and treatment of the multiple evanescent white dot syndrome （MEWDS）. Methods We retrospectively analyzed the clinical data of 8 patients diagnosed as MEWDS during the period from Jan. 2009 to Dec. 2010 in our department and reviewed their clinical features. Results All the MEWDS patients of 8 cases were monocular disease, 3 patients were male and 5 female patients. The average age was 33 years （19-48 years）. The mean onset time was 6.5 days （2-12 days）. The average corrected visual acuity at the first visit was 0.54 （0.15-0.8）. The vitreous had inflammatory cells in all the patients. And all the patients were found white circular punctate lesions located in the deep retina by fundus examination, the size of the lesion about 50-500 μ m, with unclear boundary and flat surface, 3 cases （37.5%） with optic disc hyperemia. The early of FFA, the white dots of all patients showed round hyperfluorescence making up of granu- lar focus, and strong staining then in the later; in which 4 cases （50%） with hyperfluorescence in op- tic and 3 cases （37.5%） with segmental vascular leakages. In ICGA, 8 eyes （100%） showed normal almost in the early stage, but in the later stage, there were many scattered or distributed hypofluores- cent spots with clear-border located in the posterior fundus, which were correspond with the distribu- tion characteristic of the choriocapillaris lobular. OCT showed the inner segment/outer segment （IS/OS） layer reflective disorder in which the white dots corresponding, some even completely disappeared. Post-treatment by low-dose glucocorticoid, all patients were completely cured. Conclusions MEWDS are inflammatory diseases, with quick onset and moderate impairment of visual function, and good prognosis. FFA and ICGA have important value in diagnosis and differential diagnosis, but OCT has important significance in the follow-up observation to the MEWDS.

关 键 词：白点综合征 FFA ICGA OCT 

分 类 号：R771[医药卫生—眼科]