1. IDIOPATHIC MULTIFOCAL WHITE DOT SYNDROMES
Dr George Papanikolaou
SHO in Ophthalmology,
Dept of Ophthalmology,
Singleton Hospital,
Swansea

2. MULTIPLE EVANESCENT WHITE DOT SYNDROME
MEWDS
Unilateral, Young myopic women, idiopathic, Excellent prognosis
Acute unilateral  VA, photopsia, scotomata/ Viral prodrome
Numerous migratory white dots (faint, PP, mid-periphery)
Foveal granularity- Pathognomonic- PERSISTENT
Mild papillitis/ vitritis/ disc oedema/ vasculitis
FFA: early punctate hyperfluorescence/ late: staining
ICG: typical multiple hypofluorescent spots throughout fundus
 Hypofluorescence around optic nerve
VF:  BS, disproportionate to clinical findings/ PERSISTENT
Recovery: 3-10/52, , no scarring

4. ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY/ APMPPE
Bilateral, young healthy adults, good prognosis
HLA-B7 ,DR2 / Influenza-like prodrome 50%
VA uni-  bilateral in a few days
Creamy white placoid lesions at PP (RPE level)
Mild vitritis/ vessel sheathing/ disc oedema
FFA: early: dense hypofluorescence
late: staining
Inactive: window defect
ICG: Hypofluorescence (active+healed)
Systemic microvasculopathy (Skin, kidney, CNS)
Recovery: within 1/12, depigmentation and clumping

6. SERPIGENOUS CHOROIDOPATHY
Bilateral, chronic/ recurring, progressive, 40-60y, Poor prognosis
VA uni bilateral (asymmetric), Scotomata, Photopsiae
Active: Cream coloured,hazy borders, increasing brightness/ optic disccentrifugaly/ May start ANYWHERE/ Skip- satellite lesions/ Border inactive scars (DD APMPPE)/ Vascular predilection
Anterior uveitis/ vitritis
Inactive: choroidal atrophy (large chor. vessels)
FFA: early: central hypo+ hyper rim
late: hyper leaks into the lesion (spotty staining)
Healed: visible large choroidal vessels
CNVM
No systemic associations
Rx: steroids, azathioprine, cyclosporine/ laser

8. BIRDSHOT CHORIORETINOPATHY/ BSR
Bilateral, women, middle age, guarded prognosis
Remissions- exacerbations
HLA-A29 ( HIGHEST RR of any disease~200x)
A29.2/ S-antigen/ CD8+/ Choroid + ret. vessels
Floaters, VA- nyctalopia- photopsia-  colour vision
Creamy –yellow ovoid deep spots/ centrifugal/ nasal-inferior retina
Vitritis/ vasculitis/ narrowing of vessels
CMO/ disc oedema
Chronic: well defined atrophy/ NO PIGMENT
FFA: early: normal/ ‘Quenching’ of vessels
late: leakage (intraretinal, disc)
ICG: hypo-, fuzzy choroidal vessels: Activity
Rx: steroids/ immunosuppressants

10. PUNCTATE INNER CHOROIDOPATHY
PIC
Bilateral, young myopic women, guarded prognosis
Scotomata/ photopsia/ Blurred vision
Small spots (same age),PP/ same as MCP
SRD
NO uveitis/vitritis
DD from POHS
Weeks to recover
Residual scars (with  pigment)
CNVM

12. MULTIFOCAL CHOROIDITIS WITH PANUVEITIS
MCP
Uni bi, myopic, women, middle age, fair prognosis
Subacute blurring/ photopsiea/ scotomata/ floaters/ photophobia/ pain
Multiple, deep, yellow-grey lesions
Vitritis (all)/ ant. uveitis 50% (DD POHS)
Chronic: atrophy+pigmentation
FFA: early: hypo-
late: fuzzy leaking
ICG: hypofl. spots- peripapillary
Recurrences (common)
CMO, Subretinal Fibrosis, CNVM
Rx: Steroids/ Imunosuppressants/ Laser

15. PRESUMED OCULAR HISTOPLASMOSIS SYNDROME
POHS
H. capsulatum/ Missisipi- Ohio
30-40y
Good prognosis/ 2-10% ocular lesions in endemic areas
1/1000 maculopathy
HLA DR2, HLA-B7Maculopathy
Histo spots (PP, midperiphery)/ linear streaks-equator
PPA
CNVM (v if macular spots)
Clear Vitreous, No PED
Positive skin testing/ serology/ CXR
Laser/ Surgical