International Scholarly Research Notices / 2013 / Article / Tab 1

Review Article

A Review of the Inflammatory Chorioretinopathies: The White Dot Syndromes

Table 1


ARPEMEWDSAPMPPEPICMCPAZOORBirdshotSFUSerpiginous Choroidopathy

SexM = FF > MM = FF > MF > MF > MF > MF > MM > F
AgeYoung (10 s–30 s)(20 s–50 s)(20 s–30 s)Young (≤40)(20 s–60 s)Young women(40 s–60 s)(10 s–30 s)(30 s–60 s)
LateralityVariable (Uni-75%)Mostly unilateralBilateral BilateralBilateral Bilateral but can be asymmetricBilateral Bilateral (asymmteric)Bilateral but usually asymmetric
OnsetSuddenAcuteAcuteSuddeninsidiousSuddenInsidiousAcuteVariable
Viral ProdromeVariable Variable VariableNoneVariableVariableNoneNoneNone
SymptomsDecreased visual acuity or central metamorphopsia or scotomaBlurred vision, scotomas, photopsiasBlurred vision, scotomata, PhotopsiaDecreased central visual acuity, Photopsias, ScotomataBlurred vision, scotomata, photopsias, and floatersVisual field defect, blurred vision, photopsias, whitening of visionBlurred vision, floaters, difficulty with night vision/or color vision, photopsiasDecreased vision Blurred vision, paracentral or central scotomata, photopsias
DurationWeeks-MonthsWeeks-monthsWeeks-MonthsChronicWeeks to monthsChronicChronicChronic
RecurrenceVariableRareRareRareRecurrentVariableRecurrentRecurrentRecurrent acute lesions lasting weeks-months
Findings Small hyperpigmented lesions (100–200  m)Myopia, small white dots in outer retina/RPE, may coalesce to form patches, disc edema, white/orange granularity at level of fovea and enlargement of blind spotMultifocal, Flat, Gray-white placoid lesions at the level of posterior pole RPE improving within 1-2 weeks, may have disc swellingSmall (100–300 mm in diameter) multiple gray or yellow, opaque round lesions at the level of the RPE-choroid, scattered throughout the posterior pole, evolve usually into atrophic chorioretinal scars, may be complicated by CNV or subretinal fibrosisMyopia, Iritis in 50%, Yellow-white lesions replaced by punched out scars, +/− disc swellingNormal appearing fundus or some RPE mottling or zones with retinitis pigmentosa (RP) appearancemultiple, ill-defined cream-colored lesions at level of outer retina/RPE, patches of depigmentation, otic atrophy and some disc swellingBlurred and decreased visionPseudopodial/geographic zone of gray-yellow discoloration of RPE in peripapillary/macula area with centrifugal extension with active and peripheral edge at the RPE and choriocpillaris
Vit CellsMild/noneMildMildNoneModerateNormal to mild vitritisModerateAC and Vitreous inflammationMild versus absent
FAEarly hyperfluorescence, late stainingEarly hyperfluorescence with punctate leisons in wreathlike configuration, late staining with Early block with late staining in acute phase of disease and window defects in later stage of disease processEarly block with late staining in early phase of disease and window defects in later stage of disease processEarly block with late staining in acute phase of disease and window defects in later stage of disease processNormal angiography to variable changes to include hyperfluorescence, window defects and optic nerve head leakage.May have vascular leakageYellow-white lesions (50–500  m) in the posterior pole to midperiphery, RPE hypertrophy, and atrophy and stellate zones of subretinal fibrosis Hypofluorescent early, borders stain late
ERG/EOGNormal ERG with Abnormal EOGAbnormal ERGAbnormal EOGNormal-mild changes in ERGNormal-abnormal ERGAbnormal ERGAbnormal rod and cone ERGAbnormal ERG/EOGNormal
CME/CNVNoneRareNone1/3 develop CNVCME may be seen with CNVCME RareCME, rare CNVCMECNV rare but can occur at margin of chorioretinal atrophy.
TreatmentNoneObservationObservation; consider corticosteroids with CNS involvementObservation versus oral/periocular corticosteroidsCorticosteroids; photocoagulation. PDT/Anti-VEGF for CNVNo treatment known to improve symptomsCyclosporine, Mycophenolate, methotrexate, IVIGCorticosteroids for CME, immunomodulat-ory therapy Immunosupression, antivirals, Photocoagulation for CNV
PrognosisExcellentVery GoodGoodGoodGenerally poorGood, stabilization of visual fields defects usually within 6 months of onset GuardedGuardedGuarded
EtiologyUnknown viralviral AutoimmuneViralAutoimmuneAutoimmuneAutoimmuneviral, autoimmune,
SequelaeMild RPE changesRPE mottling/
depigmentation
Scarring, CNV (30%)Punched out scars, CME, rare CNVVenous sheathing, disc edemaRPE mottling, scarring, loss of choriocapillaris, CNV
HLANoneNoneHLA-B7, HLA-DR2NoneNoneNoneHLA-A29 (strong)HLA-B7, S-antigen

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