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Two Different Cases of White Dot Chorioidal Syndromes
Löw U., Palmowski A., Ruprecht K. W.,
Universitätskliniken des Saarlandes, Augenklinik und Poliklinik (Homburg/Saar)
Purpose: The White dot syndromes (WDS) constitute a rare form of uveitis with dissiminated choroiditis. According to their clinical characteristics the following WDS can be differentiated: APMPPE, serpiginous choroidits, MEWDS, PIC, multifocal choroidits with panuveitis and Birdshot retinochoroidopathy. The classification in these groups results by the clinical status, the clinical time course and results of the fluorescein angiography. Here, we present 2 patients with different WDS.
Case presentations: Two female patients (aged 48 and 31 years respectively) presented to our hospital with a monocular reduction of vision in <0,3. The contralateral visual acuity (VA) was 1,0. Concentric restriction of the visual field and a enlarged blind spot was found on perimetry of the symptomatic eye. However, ophthalmoscopy an fluorescein angiography differend in both patients. The 48 years old patient showed swelling of the neurosensory retina surrounding the optic disc as well as multiple gray-white chorioretinal patches of the same stage on the posterior pole and in the middle periphery without scaries. Fluorescein angiography revealed a hyperfluorescence of the patches, without leaks. During the following 2 months the chorioretinal patches resolved to 0,7 without treatment, the visual field normalized. However, developed a CNV patient accompanied by a reduction in VA to 0,4. The second patient presented with vitreous cells and new chorioretinal lesions in the symptomatic eye as well as old chorioretinal scars in both eyes. Fluorescein angiography revealed a mixture of old scars with new spots in the affected eye. In addition, older lesions were seem as window defects with early hyperfluorescense and late fading the asymptomatic eye.
Conclusions: We diagnosed a MEWDS in the first patient and a multifocal choroiditis with panuveitis in the second patient. Both diseases manifest in women aged 17-50 years. The first case demonstrat, that even in WDS with a expected benign course clinical controls are necessary to identify CNV, which may develops in rare cases.