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There is Something Strange and Unusual at the Back of the Eye
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Other choroidal lesions of a worrying nature include metastasis from a systemic malignancy. Solid lesions tend to be multiple and creamy white in nature, very much larger than seen in white dot syndromes and as such are difficult to confuse with one another. Unlike melanoma, metastases tend to be flatter, exude fluid, and may demonstrate RPE clumps. The most common primary sites are the breasts in women and the lungs in men.
Punctate Inner Choroidopathy and Choroidal Neovascularization in Korean Patients
Published in Ocular Immunology and Inflammation, 2020
Ji Hwan Lee, Sung Chul Lee, Seo Jin Park, Christopher Seungkyu Lee
We retrospectively reviewed the medical records of 26 patients diagnosed with PIC between April 2004 and December 2015. PIC was diagnosed on the basis of clinical and multimodal imaging features. Eyes with typical gray or yellow, small round lesions or punched-out atrophic chorioretinal scars without signs of anterior uveitis or vitritis were included.6 Eyes with a history of inflammatory cells in the anterior chamber or vitreous cavity observed on ophthalmoscopy or spectral domain OCT (SD-OCT) were diagnosed with multifocal choroiditis with panuveitis (MCP) and excluded from the present study.11 Other white dot syndromes, including acute zonal occult outer retinopathy, diffuse subretinal fibrosis, acute posterior multifocal placoid pigment epitheliopathy, multiple evanescent white dot syndromes, and pathologic myopia, were also excluded. Fluorescent treponemal antibody absorption test, interferon-gamma release assay, and chest X-ray were performed to exclude infectious causes of posterior uveitis such as syphilis and tuberculosis. This study was approved by the Institutional Review Board of Severance Hospital, Yonsei University College of Medicine.
Multiple Evanescent White Dot Syndrome Following Acute Epstein-Barr Virus Infection
Published in Ocular Immunology and Inflammation, 2019
Chang-Sue Yang, Ming-Hung Hsieh, Huan-I Su, Yih-Shiuan Kuo
The exact etiology of the spectrum of white dot syndromes of the retina is still unknown. Jampol et al. proposed a common genetic hypothesis as the origin of many inflammatory white dot syndromes.11 The authors hypothesized that there are common nondisease specific genes in these patients that predispose them to autoimmune diseases.11 When specific environmental triggers such as viruses or other pathogens interact with susceptive genes, these patients develop specific autoimmune inflammatory chorioretinopathy. Tezel and Kaplan et al. also reported the simultaneous occurrence of multifocal choroiditis and MEWDS in the same eye.12 The authors proposed the sensitization of the patient to autoantigens within the retinal pigment epithelium, photoreceptors, or choroid by exogenous triggering pathogens.12 In the literature, the reported trigger pathogens of multifocal choroiditis included fungus,13 Brucella,14 Varicella-Zoster virus,15 and Epstein-Barr virus.16 Epstein-Barr virus has been suspected to be an important environmental factor for the development of systemic autoimmune diseases including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and Sj¨ogren’s syndrome (SS).17
Review of the Current Literature and Our Experience on the Value of OCT-angiography in White Dot Syndromes
Published in Ocular Immunology and Inflammation, 2022
Céline Mebsout-Pallado, Raphaëlle Orès, Céline Terrada, Kunal K. Dansingani, Jay Chhablani, Andrew W. Eller, Joseph N. Martel, Alexander Anetakis, Jean C. Harwick, Evan L. Waxman, Denise S. Gallagher, Colin Prensky, Chad Indermill, Neila Sedira, Emmanuel Héron, Michel Paques, Françoise Brignole-Baudouin, Bahram Bodaghi, José-Alain Sahel, Alain Gaudric, Sarah Mrejen, Marie-Hélène Errera
The term “white dot syndromes” is used to refer to a heterogeneous group of chorioretinal inflammatory diseases. Apart from grouping these conditions and reminding us that they can feature multiple inflammatory lesions in various configurations, the term “white dot syndrome” is of limited value as it does not convey useful information about etiology, classification, or treatment of these conditions. In addition, other uveitis may take on the appearance of white spot syndrome such as those associated with tuberculosis or syphilis for example. It is important to try to distinguish the etiologies underlying “white dot syndromes” because their causes may vary and their treatments differ.