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Cicinelli MV, Ramtohul P, Marchese A, Bandello F, Bailey Freund K, Miserocchi E, Jampol LM. Latest advances in white spot syndromes: New findings and interpretations. Prog Retin Eye Res 2023; 97:101207. [PMID: 37574123 DOI: 10.1016/j.preteyeres.2023.101207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
White spot syndromes (WSS) pose challenges in the field of ophthalmology, particularly in terms of accurate diagnosis and effective management. However, recent advancements in multimodal imaging (MMI) have significantly contributed to our understanding of WSS, allowing for improved characterization of these inflammatory chorioretinopathies. By employing various imaging modalities, including fundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence, optical coherence tomography (OCT), ultra-widefield imaging, and OCT angiography, researchers and clinicians have gained valuable insights into the underlying pathophysiological changes and clinical progression of WSS. Furthermore, MMI has unveiled novel and atypical variants within the spectrum of WSS, expanding our knowledge in this field. Notably, the identification of secondary forms of WSS occurring concurrently with unrelated chorioretinal disorders has suggested a potential autoimmune mechanism underlying these conditions. The introduction of MMI has also facilitated a more comprehensive evaluation of previously ill-defined entities, such as acute zonal occult outer retinopathy, leading to improved diagnostic criteria and enhanced recognition of distinct features. This review paper provides a comprehensive overview of the latest advances and interpretations in WSS. By integrating MMI into the diagnosis and management of these conditions, this review aims to enhance patient outcomes and provide valuable insights into the complexities surrounding WSS.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Prithvi Ramtohul
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; NYU Grossman School of Medicine, New York, NY, USA
| | - Alessandro Marchese
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; NYU Grossman School of Medicine, New York, NY, USA
| | - Elisabetta Miserocchi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lee M Jampol
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Köksaldı S, Tunc M, Saatci AO. Unilateral Multiple Evanescent White Dot Syndrome-Like Reaction Following the CyberKnife Stereotactic Radiotherapy for Choroidal Malignant Melanoma. Turk J Ophthalmol 2023; 53:261-265. [PMID: 37602675 PMCID: PMC10442750 DOI: 10.4274/tjo.galenos.2023.93507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/27/2023] [Indexed: 08/22/2023] Open
Abstract
A 58-year-old otherwise healthy man received a diagnosis of choroidal malignant melanoma (CMM) in June 2021 and underwent a single session of (21 Gy) CyberKnife stereotactic radiotherapy (SRT). Eleven months later, we noticed 3+ anterior chamber cells with occasional vitreous cells in the left eye. Though the tumor looked regressed, there were mild optic disc leakage, early hypofluorescent and late hyperfluorescent punctate lesions scattered 360 degrees, and late staining of the mass on fluorescein angiogram. The findings were compatible with a unilateral multiple evanescent white dot syndrome (MEWDS)-like reaction that was most likely related to CyberKnife SRT-induced tumor necrosis, and a dexamethasone implant was administered intravitreally into the left eye together with topical steroids. A second intravitreal injection of dexamethasone was given three months later due to remittance of the angiographic features. As there are only a few reports on CyberKnife SRT for the treatment of CMM, we wanted to share our interesting observation of a post-treatment MEWDS-like reaction likely related to tumor necrosis syndrome with the ophthalmic community.
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Affiliation(s)
- Seher Köksaldı
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Türkiye
| | - Murat Tunc
- Tunç Clinic of Ophthalmology, Ankara, Türkiye
| | - Ali Osman Saatci
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Türkiye
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Gallo B, Talks JS, Pandit RJ, Browning AC. Multiple Evanescent White Dot Syndrome and Choroidal Neovascularization following SARS-COV-2 Infection in a Patient on Dabrafenib and Trametinib. Ocul Immunol Inflamm 2022; 31:641-648. [PMID: 35226581 DOI: 10.1080/09273948.2022.2042320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE to describe multimodal imaging and electrophysiology of multiple evanescent white dot syndrome (MEWDS) concomitant with COVID-19 infection in a patient on BRAF (B Rapidly Accelerated Fibrosarcoma) and MEK (Mitogen-activated Protein Kinase) inhibitors. METHODS observational case report and literature review. RESULTS a 37-year-old woman affected by cutaneous melanoma on BRAF and MEK inhibitors developed visual symptoms in the right eye simultaneously with a SARS-COV-2 infection. The right eye visual acuity was hand movement, and clinical examination disclosed vitreous cells, yellow-white retinal spots, and macular yellowish material. Fundus autofluorescence and angiograms were consistent with MEWDS. Angiograms, optical coherence tomography, and optical coherence tomography angiography revealed a macular choroidal neovascular membrane. The infectious and inflammatory work-up was negative. Electrodiagnostic tests revealed cone dysfunction. MEWDS resolved and anti-VEGF treatment allowed partial vision recovery. CONCLUSION the case illustrates the association of MEWDS and choroidal neovascularization developing after COVID-19 infection in the setting of immunotherapy.
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Affiliation(s)
- Beatrice Gallo
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - James S Talks
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ranjeet J Pandit
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Andrew C Browning
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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DIFFERENTIAL RESPONSE TO GLUCOCORTICOID IMMUNOSUPPRESSION OF TWO DISTINCT INFLAMMATORY SIGNS ASSOCIATED WITH PUNCTATE INNER CHOROIDOPATHY. Retina 2021; 41:812-821. [PMID: 32804829 DOI: 10.1097/iae.0000000000002950] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe the differential response of two distinct inflammatory signs occurring in eyes with punctate inner choroidopathy. METHODS Retrospective, observational case series using multimodal imaging. RESULTS Four eyes of 4 myopic female patients (mean age of 35 years, range 31-42 years) presenting with retinal manifestations of punctate inner choroidopathy. All study eyes had 2 distinct signs of active disease: 1) acute focal hyperreflective lesions splitting the retinal pigment epithelium/Bruch membrane complex on optical coherence tomography which appeared hypoautofluorescent on fundus autofluorescence and 2) more diffuse areas of outer retinal disruption limited to the ellipsoid zone and interdigitation zone on optical coherence tomography and corresponding to hyperautofluorescence on fundus autofluorescence. All patients were treated with oral prednisone and demonstrated prompt regression of the retinal pigment epithelium/Bruch membrane complex lesions with a concurrent, paradoxical centrifugal expansion of outer retinal disruption. The outer retinal disruption eventually resolved in all eyes (mean time of 6 weeks, range 4-10 weeks). CONCLUSION In patients with punctate inner choroidopathy, two distinct inflammatory signs observed with multimodal imaging display a differential response to systemic corticosteroids. Although focal inflammatory lesions splitting the retinal pigment epithelium/Bruch membrane complex seem to respond rapidly, the more diffuse, transient outer retinal disruption shows little response. This difference in treatment response may reflect different immunological phenomena with independent natural history.
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Minkus CL, Lavine JA, Lee J, Skondra D, Goldstein DA. Use of Short-wave Blue Fundus Autofluorescence to Detect and Monitor Acute Regional Outer Retinopathy in Punctate Inner Choroidopathy. Ocul Immunol Inflamm 2021; 30:887-893. [PMID: 33544644 DOI: 10.1080/09273948.2020.1849736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To describe the utility of fundus autofluorescence (FAF) for detection and monitoring of acute regional outer retinopathy in punctate inner choroidopathy (PIC).Design: Multimodal imaging case series.Methods: Patients with PIC and acute regional hyperautofluorescence were identified. Multimodal imaging, treatment, and clinical course were reviewed.Results: Six eyes of five patients were included (5 women, mean age 39 years, range 28-69). All endorsed new symptoms. Short-wave blue FAF revealed regional hyperautofluorescence in the symptomatic eye, corresponding to ellipsoid zone (EZ) loss on optical coherence tomography (OCT). All patients were treated with local or systemic corticosteroids or immunosuppression, with resolution of symptoms and acute imaging abnormalities.Conclusions: Symptomatic acute regional outer retinopathy in PIC, manifesting as hyperautofluorescence and EZ loss, is easily identifiable using widefield FAF imaging. Treatment resulted in resolution of symptoms and imaging findings in our cohort, and should be considered in this patient population.
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Affiliation(s)
- Caroline L Minkus
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jeremy A Lavine
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jennifer Lee
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dimitra Skondra
- Department of Ophthalmology, University of Chicago, Chicago, IL, USA
| | - Debra A Goldstein
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Gliem M, Birtel J, Müller PL, Hendig D, Faust I, Herrmann P, Holz FG, Adamus G, Charbel Issa P. Acute Retinopathy in Pseudoxanthoma Elasticum. JAMA Ophthalmol 2019; 137:1165-1173. [PMID: 31393536 DOI: 10.1001/jamaophthalmol.2019.2910] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Acute retinopathy may partly explain variable disease manifestation and vision loss in patients with pseudoxanthoma elasticum (PXE). The diagnosis of this likely autoimmune process may inform patient counseling and treatment approaches. Objective To characterize acute retinopathy in patients with PXE as a disease manifestation that may be associated with profound visual impairment. Design, Setting, and Participants This single-center case series was conducted from May 2013 to October 2018. It used the patient database of the Department of Ophthalmology at the University of Bonn, a referral center for PXE in Germany. Patients at this center with genetically confirmed PXE and who met the inclusion criteria were included (n = 9). Patients underwent multimodal retinal imaging, including fundus photography, fundus autofluorescence (AF), optical coherence tomography (OCT), fluorescein angiography (FA), and indocyanine green angiography (ICGA); in select cases, electroretinography as well as antiretinal and anti-retinal pigment epithelium (RPE) antibody testing were also used. Main Outcomes and Measures Clinical presentation and disease course. Results Nine patients (8 [89%] female; mean [range] age, 43 [19-55] years) with acute retinopathy were identified in a cohort of 167 consecutive patients with PXE (frequency of 5%). Symptoms ranged from light sensations or metamorphopsia to profound vision loss. Visual acuity was reduced in 6 patients (67%), ranging from a best-corrected visual acuity of 20/30 to perception of hand movements at manifestation. All patients revealed characteristic fundus features with temporary appearance of partly confluent outer retinal whitish dots at the posterior pole, which corresponded to areas of hyperautofluorescence on fundus AF, loss of the ellipsoid band on OCT, and associated scotomata. The FA and late-phase ICGA imaging showed associated hyperfluorescence and hypocyanescence. Electroretinography revealed a variable reduction of amplitudes. Changes were fully reversible within 1 month in 3 of 8 patients with available follow-up data. Of the remaining 5 patients, 3 had a prolonged and likely permanent vision loss (observation period, 1-64 months) mainly owing to central subretinal hyperreflective material originating from angioid streaks. In 4 (67%) of 6 tested, antiretinal and/or anti-RPE antibodies were detected. Conclusions and Relevance Acute retinopathy in patients with PXE may occur, with symptoms ranging from short-term, reversible alterations to irreversible vision loss; these findings contribute to understanding the variable ocular disease progression in PXE and provide insights into the autoimmune phenomena of the posterior pole.
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Affiliation(s)
- Martin Gliem
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,Center for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, Germany.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Johannes Birtel
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,Center for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, Germany
| | - Philipp L Müller
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,Center for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, Germany
| | - Doris Hendig
- Institute for Laboratory and Transfusion Medicine, Heart and Diabetes, Center North Rhine-Westphalia, University Hospital of the Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - Isabel Faust
- Institute for Laboratory and Transfusion Medicine, Heart and Diabetes, Center North Rhine-Westphalia, University Hospital of the Ruhr University of Bochum, Bad Oeynhausen, Germany
| | - Philipp Herrmann
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,Center for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,Center for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, Germany
| | - Grazyna Adamus
- Ocular Immunology Laboratory, Casey Eye Institute, Oregon Health and Science University, Portland
| | - Peter Charbel Issa
- Department of Ophthalmology, University of Bonn, Bonn, Germany.,Center for Rare Diseases Bonn (ZSEB), University of Bonn, Bonn, Germany.,Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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