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IDIOPATHIC INFLAMMATORY WHITE DOT SYNDROMES

IDIOPATHIC INFLAMMATORY WHITE DOT SYNDROMES. 1. Multiple evanescent white dot syndrome (MEWDS). 2. Acute posterior multifocal placoid pigment epitheliopathy (APMPPE). 3. Punctate inner choroidopathy (PIC). 4. Birdshot retinochoroidopathy.

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IDIOPATHIC INFLAMMATORY WHITE DOT SYNDROMES

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  1. IDIOPATHIC INFLAMMATORY WHITE DOT SYNDROMES 1. Multiple evanescent white dot syndrome (MEWDS) 2. Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) 3. Punctate inner choroidopathy (PIC) 4. Birdshot retinochoroidopathy 5. Multifocal choroiditis with panuveitis 6. Serpiginous choroidopathy

  2. MEWDS • Young adults (F > M) • Unilateral • Small, subtle, deep grey-white dots • Orange macular granularity • Mild vitritis Posterior pole Mid-periphery

  3. FA of MEWDS Many hyperfluorescent spots at posterior pole Increase in hyperfluorescence and late leakage from disc

  4. MEWDS • Treatment - nil • Course - 6 weeks • Complications - nil • Prognosis - excellent Residual blind spot enlargement

  5. APMPPE • Young adults (F=M) • Associated with HLA-B7 and DR2 • Bilateral and symmetrical • Large, deep, grey-white, placoid lesions • Mainly at posterior pole • Mild vitritis

  6. FA of APMPPE Early dense hypofluorescence Late staining

  7. APMPEE • Treatment - nil • Course - 4 weeks • Complications - nil • Prognosis - good Residual RPE changes

  8. Punctate inner choroidopathy ( PIC ) • Young, myopic females • Eventually bilateral but asymmetrical • Deep, small, indistinct yellow spots at • posterior pole • All same age • No vitritis

  9. FA of punctate inner choroidopathy Focal hyperfluorescent spots No increase in size

  10. Punctate inner choroidopathy • Treatment - not beneficial • Course - several weeks • Complications - occasional choroidal neovascularization • (CNV ) • Prognosis - guarded Residual dumb-bell shaped scars

  11. FA of CNV in punctate inner choroidopathy Early hyperfluorescence Progressive leakage

  12. Birdshot retinochoroidopathy • Middle-aged (F > M) • HLA - A29 • Deep, oval, creamy, indistinct spots • Radiate from disc towards equator • Moderate vitritis

  13. FA of birdshot retinochoroidopathy • Venous hyperfluorescence • Extensive late intraretinal and disc leakage

  14. Birdshot retinochoroidopathy • Treatment - steroids and immunosuppressive agents • Course - chronic-remittent • Complications - CMO • Prognosis - guarded Residual punched-out, non-pigmented scars

  15. Multifocal choroiditis with panuveitis • Adults (20-50) ( F  M ) • Bilateral but asymmetrical • Deep, discrete, grey-yellow spots • Mixed fresh and old • Mid-periphery and fewer at posterior pole • Moderate to severe panuveitis

  16. Multifocal choroiditis with panuveitis • Treatment - steroids • Course - chronic-remittent • Complications - CMO and occasional subretinal fibrosis • Prognosis - guarded Residual pigmented scars

  17. Serpiginous choroidopathy • Middle age (F = M) • Eventually bilateral but asymmetrical • Deep, grey-white lesions with hazy • borders • Initially peripapillary and at • posterior pole then outward spread • Mild vitritis

  18. Serpiginous choroidopathy • Treatment - steroids and immunosuppressive agents • Course - chronic-remittent • Complications - macular scarring • Prognosis - poor Residual scalloped, punched-out areas

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