Purpose:
To determine the diagnostic utility of radiographic and serologic tests in the evaluation of patients with white dot syndromes.
Methods:
The records of patients from 2001 to 2011 with white dot syndromes seen at the Emory University Department of Ophthalmology were retrospectively reviewed. Inclusion criteria included patients with the following diagnosis: acute posterior multifocal placoid pigment epitheliopathy (APMPPE), multiple evanescent white dot syndrome (MEWDS), serpiginous choroiditis, ampiginious choroidopathy, multifocal choroiditis with panuveitis (MFC), birdshot retinochoroidopathy, and punctate inner choroiditis (PIC). Charts were reviewed for radiographic and serologic testing. Diagnostic yield, sensitivity, and predictive values were calculated for the diagnostic tests.
Results:
Fourty-one white dot syndrome patients were identified (29 female, 12 male). Diagnoses included birdshot retinochoroidopathy (20), serpiginous choroiditis (5), MFC (5), PIC (4), ampiginous (3), APMPPE (2) and MEWDS (2). Thirty-one patients underwent laboratory and/or radiographic evaluation for infectious and autoimmune conditions. A total of 148 tests were performed (Mean 4.8 tests/patient). Fifteen positive tests were identified for a diagnostic yield of 10.1%. All diagnostic testing results were normal with the exception of 12 of 13 positive HLA-A29 tests, 1 of 16 ACE levels, and 2 of 15 positive Quantiferon-Gold tests, one in a patient with HLA-A29+ birdshot retinochoroidopathy and another in a patient with serpiginous choroidopathy. Isoniazid therapy was recommended in both of these patients. Of laboratory testing performed, the positive predictive value (100%) and sensitivity (92.3%) were highest for HLA-A29-testing in birdshot retinochoroidopathy.
Conclusions:
Laboratory and radiologic testing for the white dot syndromes were of low diagnostic yield with the exception of HLA-A29-testing for birdshot retinochoroidopathy. Quantiferon-testing was relevant, altering treatment prior to immunosuppression in two patients in this series. Consideration should be given to a limited workup for the white dot syndromes.
Keywords: chorioretinitis • clinical laboratory testing