摘要目的 观察多发性一过性白点综合征(MEWDS)患眼的眼底多模式影像特征.方法 回顾性病例研究.2015年9月至2017年4月在佛山市第二人民医院眼科中心检查确诊且资料完整的MEWDS患者18例18只眼纳入研究.其中,男性6例,女性12例.均为单眼发病.平均年龄35.9岁.病程(出现症状至就诊时间)3～90 d,平均病程14d.所有患者均行BCVA、裂隙灯显微镜联合+90D前置镜、眼底彩色照相、频域OCT(SD-OCT)、FAF检查.行FFA检查6只眼,FFA联合ICGA检查12只眼.给予糖皮质激素或血管扩张剂等治疗10例,未行任何治疗8例.平均随访时间4.5个月.观察病灶在彩色眼底像、FFA、ICGA、FAF、SD-OCT中的影像特征.结果 18只眼中,眼底可见灰白色点状或斑片状病灶14只眼,其中伴黄斑颗粒样改变7只眼,视盘充血5只眼;豹纹状眼底4只眼,白色斑点病灶不可见.FAF检查,病灶呈点状颗粒状或斑片状强自身荧光(AF);FFA检查,早期病灶呈针尖样花环状排列或斑片状融合的强荧光;ICGA检查,晚期病灶呈边界不清可融合成片的弱荧光,其中点状和斑片状弱荧光重叠共存10只眼.SD-OCT检查,所有患眼椭圆体带断裂、萎缩,结构不清,伴强反射物质沉积和玻璃体腔细胞9只眼.发病后1～3个月,17例患者自述BCVA恢复至发病前;FAF、FFA、ICGA、SD-OCT检查未见明显异常.1例患者糖皮质激素减量期间或自行停药复发2次,末次随访时BCVA数指/40 cm;黄斑区椭圆体带萎缩,团块状强反射物质沉积.结论 MEWDS患眼伴或不伴黄斑区颗粒样改变;呈颗粒状或片状强AF;FFA早期病灶表现为细针样花环状排列或斑片状融合的强荧光;ICGA晚期病灶呈片状融合的弱荧光;SD-OCT表现为病灶处椭圆体带断裂、萎缩,结构不清.

abstractsObjective To observe the multimodal imaging characteristics of multiple evanescent white dot syndrom (MEWDS).Methods This was a retrospective series case study.Eighteen patients (18 eyes) diagnosed with MEWDS in Eye Center of The Second People's Hospital of Foshan from September 2015 to April 2017 were enrolled in this study.There were 12 females and 6 males,with the mean age of 35.9 years.The disease course ranged from 3 to 90 days,with the mean of 14 days.All the patients underwent BCVA,slit-lamp microscope with +90D preset lens,fundus photography,spectral domain OCT (SD-OCT) and FAF examinations.FFA was simultaneously performed in 6 eyes,FFA and ICGA were simultaneously performed in 12 eyes.Ten patients received the treatment of glucocorticoids and vasodilator substance,and other 8 patients without any treatment.The follow-up duration was 4.5 months.The multimodal imaging characteristics were reviewed and analyzed.Results Fundus color photography showed a variable number of small dots and large spots lesions (14 eyes),and/or fovea granularity (7 eyes) and disk swelling (5 eyes).A variable number of little dots and larger spots lesions showed respectively in FFA,FAF and ICGA were needle-like dots distributed in a wreathlike pattern and a large plaque occasionally confluent of early highly fluorescent,highly autofluorescence and hypofluoresence.Combined hypofluorescent spots with overlying dots were observed in 10 eyes of the late stages of the ICGA.Black lesions in the gray background show in ICGA were the most obvious and the most extensive,gray-white lesions in the gray-black show in FAF were the second,light gray-black lesions in the gray show in FFA were the least.Gray-white lesions in an orange background show in fundus photography were not obvious and transient.SD-OCT showed disruption of the ellipsoid zone and/or accumulations of hyperreflective material from the ellipsoid layer toward the outer plexiform layer and vitreous cells.During the period of following-up,some patients were prescribed low-dose glucocorticoid and some not,almost all the patients except one patient experienced recovery in BCVA and the lesions in fundus imaging.Conclusions The lesions in MEWDS eyes in modern multimodal imaging modalities among fundus photography (fovea granularity),FFA (needle-like dots distributed in a wreathlike pattern and a large plaque occasionally confluent of early highly fluorescent),ICGA (flake hypofluorescent) and SD-OCT (disruption of the ellipsoid zone) showed good consistency.Almost eyes were recovery.