Grand Rounds Jinghua Chen, MD, PhD October 21, 2016 Department of Ophthalmology and Visual Sciences History CC: 29 yo young male complained of sudden blurred vision in right eye. HPI: This is a 29 yo young male from Peru who came to
US two months ago to study. Two nights ago he stayed very late to study for an exam. He noticed that he could only see periphery with right eye, central vision was very blurry. Past Medical History POH: Refractive error OU
No insurance Oral Prednisone (20 mg po tid) x 3 days To return in 1 week for follow up. If symptoms don't resolve- medical work up Chest imaging
Serological testing Two Weeks Later Vision 20/20 OD and 20/30 OS OCT White Dot Syndromes (WDS) Multiple evanescent white dot syndrome Multifocal choroiditis and panuveitis ( MCP )
Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) Birdshot chorioretinopathy Punctate inner choroidopathy (PIC) MULTIFOCAL CHOROIDITIS AND PANUVEITIS ( MCP ) Myopic females (30s to 50s),bilateral Vitritis mild to moderate
Chorioretinal lesions At the level of the RPE and choriocapillaris From 50 to 350 m Lesions become atrophic with varying degrees of pigmentation and scarring Vision out come Cystoid macular edema (10-20%) CNVM in 25-39% of pts
Multiple Evanescent White Dot Syndrome (MEWDS) First described by Jampol L. M in 1984 Young, healthy women in the second to fourth decades of life Symptoms: a viral prodrome unilateral, acute painless vision loss
an enlarged physiologic blind spot shimmering photopsias Multiple Evanescent White Dot Syndrome (MEWDS) Multiple white spots at the level of the RPE or deep retina 100 and 200 m in size Posterior pole
An orange-yellow fovea with granularity Vitreous inflammation, optic disc edema. Multiple Evanescent White Dot Syndrome (MEWDS) FA reveals early punctate hyperfluorescence in a wreath-like pattern and late staining
OCT: Discontinuities in inner segmentouter segment junction Immune-mediated vascular inflammation that affects various retinal layers, including the choroid, RPE and photoreceptors.2,5 Early identification MEWDS is generally benign APMPPE may be associated with systemic vasculitis.
MCP has a chronic recurrent course responsive to anti-inflammatory therapy. PIC a significant risk of choroidal neovascular membrane formation References 1.
BSCS 2014-2015 Book 12, Retina and Vitreous: 185-193 2. 3. BCSC 2014-2015 Book 9, Intraocular Inflammation and Uveitis 147-172 Jampol LM, Sieving PA, Pugh D, et al. Multiple evanescent white dot syndrome. I. Clinical findings. Arch Ophthalmol 1984;102:671-4. Aaberg TM, Campo RV, Joffe L. Recurrences and bilaterality in the multiple evanescent white-dot syndrome. Am
J Ophthalmol 1985;100:29-37. Mamalis N, Daily MJ. Multiple evanescent white dot syndrome. A report of eight cases. Ophthalmology 1987;94:1209-12. Dreyer R, Gass JDM. Multifocal choroiditis and panuveitis: A syndrome that mimics ocular histoplasmosis. Arch Ophthalmol. Vol 102, Dec 1984:1776-1784. Dunlop A, Cree I, Hague S, Luthert P, Lightman S. Multifocal choroiditis: Clinicopathologic correlation. Arch Ophthalmol. 1998; 116:801-803 4.
5. 6. 7. 8. 9. Fung AT, Pal S, Yannuzzi NA, Christos P, Cooney M, Slakter JS, Klancnik JM Jr, Freund KB, Cunningham ET Jr, Yannuzzi LA.Retina. 2014 Jan;34(1):98-107.Multifocal choroiditis without panuveitis: clinical characteristics and progression.
Dunlop A, Cree I, Hague S, Luthert P, Lightman S. Multifocal choroiditis: Clinicopathologic correlation. Arch Ophthalmol. 1998; 116:801-803.) 10. Thorne J, Wittenberg S, Jabs D, Peters G, Reed T, Kedhar S, Dunn J. Multifocal choroiditis with panuveitis:Incidence of ocular complications and loss of visual acuity. Ophthalmology 2006;113:2310-2316. 11. Fine HF, Zhitomirsky I, Freund KB, Barile GR, Shirkey BL, Samson CM, Yannuzzi LA. Bevacizumab (avastin) and ranibizumab (lucentis) for choroidal neovascularization in multifocal choroiditis. Retina 2009 Jan:29(1) :8-12. Thank you!
MEWDS Original Description Department of Ophthalmology and Visual Sciences Multiple Evanescent White Dot Syndrome (MEWDS)
Who usually presents with MEWDS? Women, 14-47 Is the disease unilateral or bilateral?
Unilateral Can the disease be recurrent? Yes, but rarely What is the visual prognosis? Excellent, with recovery in 1-2 months
Which of the following is not associated with MEWDS acute macular neuroretinopathy, Lyme disease, enlarged blind spot? Lyme disease
Density and Layers of the Earth. Do Now. SWBAT identify and explain the layers of the Earth . Enter silently. Grab materials, folders, notebooks. Begin Do Now. Write a hypothesis in an if-then-because . ... Has feathers like a duck....
Target Audiences (Recipients): Active duty, National Guard, Reserve and commissioning sources (age 18-25), military spouses and children (emphasis on teens). Transitioning active duty, National Guard, Reserve, military veterans and their spouses. In-Scope. Financial readiness curriculum focused on budgeting, building credit,...
Graduated Symbol Maps. Use symbols of different sizes to show different amounts of something. Larger size = More. Smaller = Less. Isoline aka Isometric Maps. Use lines to connect points of equal value of something. Shows variations across space.
The Byronic hero: aristocratic, darkly handsome, manly, brooding, brilliant, erotic, melancholy, indomitable. ... the romantics explored the depths of their own souls." (Fiero 705) "I am made unlike anyone I have ever met: I will even venture to say that...
The New American Empire, 1865-1914. Josiah Strong and the White Man's Burden. Business and Empire. Mahan and The Influence of Sea Power Upon History. William Seward. John Hay. The "Open Door" and Spheres of Influence. U.S. Involvement in Cuba.
May contain evidence that a certain research thought to be important (why would this be a problem?) Are unlikely to be representative of people in general. Yet…provide valuable material for further research and serve as testing ground for new treatment,...
Cyber-Ethics Assignment PRE-OUTLINE This assignment is designed to help you prepare to write a well-formed, OUTLINE for a 5-paragraph (intro, 3 body points, conclusion) essay. List THREE (3) arguing points for the claim below.
Classical China - Class System. The most shaped by "state actions" than any other society - Powerful Centralized Bureaucracy- officials were the social elite. World's first civil service exam - est. 124bce by Emperor Wudi- around 30,000 students by end...
Ready to download the document? Go ahead and hit continue!