April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Value of Diagnostic Work-up in the Evaluation of White Dot Syndromes
Author Affiliations & Notes
  • Neal Palejwala
    Casey Eye Institute, Portland, OR
  • Gagan Sawhney
    Emory Eye Center, Atlanta, GA
  • Matthew Raeker
    Casey Eye Institute, Portland, OR
  • Steven Yeh
    Emory Eye Center, Atlanta, GA
  • Christina J Flaxel
    Casey Eye Institute, Portland, OR
  • Footnotes
    Commercial Relationships Neal Palejwala, None; Gagan Sawhney, None; Matthew Raeker, None; Steven Yeh, None; Christina Flaxel, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 5293. doi:
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    • Get Citation

      Neal Palejwala, Gagan Sawhney, Matthew Raeker, Steven Yeh, Christina J Flaxel; Value of Diagnostic Work-up in the Evaluation of White Dot Syndromes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5293.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

White dot syndromes are a heterogenous group of disorders affecting the outer retina, retinal pigment epithelium, and choroid. They have many distinctive and shared clinical features and can vary significantly in visual prognosis. Their pathogenesis is not completely known but many infectious and non-infectious etiologies have been proposed. There can be significant variability and overlap in the clinical presentation. Also, masquerade syndromes such as syphilis, sarcoidosis, leukemia/lymphoma can have similar manifestations. Because of the non-specificity of the clinical exam, often times clinicians perform multiple diagnostic tests to confirm and rule-out other diagnoses. In this study, we attempt to evaluate the yield of diagnostics in the work-up of white dot syndromes.

 
Methods
 

This study is a retrospective review of consecutive patients identified with a clinical diagnosis of a white dot syndrome (Acute Posterior Multifocal Placoid Pigment Epitheliopathy, Serpigenous Choroiditis, Multiple Evanescent White Dot Syndrome, Birdshot Choroidopathy, Multifocal choroiditis, Punctate Inner Choroidopathy) at 2 major university centers: Emory Eye Center and Casey Eye Institute. Charts were reviewed for diagnostic testing performed and diagnostic yield was calculated.

 
Results
 

Eighty-five patients were identified. Sixty-eight percent were female. The mean age was 44.9 years. A total of 404 laboratory and radiographic tests were performed of which 11.1% had a positive diagnostic yield. An average of 4.5 tests were performed per patient. The most common tests ordered were a complete blood count and metabolic panel. The highest diagnostic yield was found with HLA-A29 DNA typing to confirm the diagnosis of birdshot choriodopathy (yield- 91%). RPR, FTA-ABS, PPD, and ACE were ordered in 52, 45, 44, and 41 patients, respectively. Of these, only 1 patient had a reactive PPD.

 
Conclusions
 

Laboratory and radiographic testing for white dot syndromes were of low diagnostic yield with the exception of HLA-A29 testing for birdshot choroidopathy. Although diagnoses such as syphilis, tuberculosis, and sarcoidosis should be considered in these cases, diagnostic testing should be ordered when clinical suspicion is high. Consideration should be given for limited workups for these patients.

 
Keywords: 746 uveitis-clinical/animal model • 688 retina  
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