Author: Berta Sánchez Fernández (Spain)
Co-authors: José Diaz Bernal, José Mora Castilla, Isabel María Baquero Aranda, Antonio Moreno Guerrero
To report the clinical evolution and treatment of two different cases of white dots syndromes. Despite their etiology is incompletely understood, is critical to exclude alternative diagnoses including infections and neoplasia. We present follow up, testing, and multimodal imaging of two different cases.
The patients are currently followed up in Antonio Moreno Eye Clinic.
Two different young women came to the clinic presenting different symptoms. The first case debut with painless monocular blurring (BCVA 0,6) after viral prodrome on the previous week. The second case came presenting sudden unilateral peripheral scotoma, myodesopsias and photopsia (BCVA 1). Ultra wide-field examination demonstrates multiple small creamy yellow lesions in both posterior poles and semi-periphery in both cases. Anterior pole exploration was anodyne, IOP values were within normal limits and no signs of uveitis were found in none of the cases. OCT showed inner/outer segment junction disruption and FAF showed hyperautofluorescent spots.
Systemic diseases including infectious, inflammatory and neoplasia were discarded. All tests were negative including complete blood count, treponema antibody, angiotensin converting enzyme, C-reactive protein, toxoplasmosis and tuberculosis. HLA typing was negative for B27, DR2 and A29. The first case was treated using oral prednisone improving during the next two months until BCVA reached 1 and the second case improved spontaneously by 4 weeks without using any treatment.
Establishing the diagnosis of white dot syndrome disorders may be a difficult issue because early, clinical presentation can be misdiagnosed. Besides, the white dots syndromes do not usually fit into a specific category. Multimodal imaging and appropriate testing are necessary to rule out possible neoplastic and infectious diseases.
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