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L. Huang, H. El-Fishawe, R.F. Spaide; Characteristics of Multiple White Dot Syndromes Appearing Simultaneously: A Report of Two Unique Cases . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4919.
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Background: The white dot syndromes are a group of inflammatory conditions of the eye which cause multifocal lesions in the retina and choroid. It has been proposed that some of these entities, particularly multifocal choroiditis and panuveitis (MCP) and multiple evanescent white dot syndrome, may actually represent the same disease based on reported cases where characteristic features of each were found in the same patient. Purpose: To demonstrate that patients may simultaneously display features characteristic of multiple white dot syndromes in the same eye. Methods: Retrospective review of 2 patients who had features of acute posterior multifocal placoid pigment epitheliopathy (APMPPE), serpiginous choroiditis, and MCP develop simultaneously in the same eye. Results: Case 1: 33-year-old healthy man who presented with decreased visual acuity over 2 weeks from 20/20 to 20/80 OS. Fundus examination showed placoid macular lesions characteristic of serpiginous choroiditis. In the periphery of the same eye, small punched out lesions typical of MCP were seen. Case 2: 19-year-old healthy man who presented with decreased visual acuity over one month from 20/20 to 20/400 OD and 20/20 vision OS. Fundus examination OD showed placoid macular lesions characteristic of APMPPE or serpiginous choroiditis. Simultaneously in the periphery of both eyes, punched out chorioretinal lesions, some elongated over large choroidal vessels, were seen suggesting MCP. A linear streak of atrophic chorioretinal scars, typical of MCP, was also seen in the periphery of the left eye. Fluorescein angiography in Cases 1 and 2 as well as indocyanine green angiography in Case 2 further showed simultaneous features characteristic of these typically separate syndromes. Conclusions: The appearance of features characteristic of multiple white dot syndromes simultaneously in the same patient suggest that similar ophthalmoscopic and angiographic findings may be found in these diseases. Rather than considering this to be evidence that they represent the same disease, it may be that the eye has only a limited repertoire of responses to the common mechanism of inflammation.
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