Multifocal choroiditis with panuveitis
Introduction
Introduction to multifocal choroiditis with total uveitis Multifocal choroiditis with pan uvitis (MCP) was first reported in 1984 by Dreyer and Gass for an unexplained posterior pole of multiple chorioretinitis with significant vitreous and anterior uveal inflammation. Sexual lesions. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: optic atrophy glaucoma
Cause
Multifocal choroiditis with the cause of total uveitis
Causes:
The cause is unclear. Some people think that viral infection plays a role in its occurrence. The evidence is:
1 The herpes simplex virus type I is cultured in the patient's intraocular specimen;
2 patients have anti-viral antibodies, but these results are only found in a small number of patients. There is no more experimental data to support this view. Some people think that the disease may have genetic factors, infection factors and immune factors. However, this view still needs more research to confirm.
Prevention
Multifocal choroiditis with prevention of total uveitis
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Multifocal choroiditis with complications of uveitis Complications, optic atrophy, glaucoma
The most common complication is the subretinal neovascular membrane, the incidence rate is as high as 32% to 46%, mostly occurs in the retinal atrophic lesion or new subretinal lesions, the neovascular membrane can occur in the fovea and other fundus The site may appear in a single or multiple appearances; about 1/3 of the patients have optic disc congestion and swelling; 14% to 41% of patients have cystoid macular edema, in addition to the retinal anterior membrane, optic atrophy, neovascularization Glaucoma, subretinal fibrosis and other complications.
Symptom
Multifocal choroiditis with symptoms of uveal inflammation Common symptoms Uveitis cystoid edema congestion monocular eye shadow
Most patients complained of decreased vision, dark spots, flashing and flying mosquitoes. The incidence of both eyes was 66% to 79%, but the symptoms of both eyes were asymmetrical. The visual acuity was 1.0 to light, but most of them were 0.4 to 0.5. Examination of about 50% of patients with mild, moderate anterior uveal inflammatory manifestations, such as posterior corneal deposition, post-iris adhesion, aqueous humor and flash phenomenon, more than 76% of patients with mild, moderate vitreous inflammatory cells The vitreous inflammatory manifestations are often more pronounced than in the anterior chamber. In the acute phase fundus examination, multiple round or elliptical yellow-white lesions are located in the retinal pigment epithelium and choroidal capillary layer, ranging in size from 50 to 1000 m. More than 100, more appear in the vicinity of the optic disc, and spread to the fundus of the posterior to the middle part of the eye, the lesions can be distributed in a single or cluster, the peripheral lesions can also be arranged in parallel with the serrated edge in a single line, occasionally a small amount Subretinal effusion, as the disease progresses, the lesions gradually become abundance with atrophic scars with pigmentation. Some patients have optic disc edema and congestion, and atrophic foci can occur around the optic disc in the later stage. 0% to 20% of patients have cystoid macular edema, and 25% to 46% can develop macular or choroidal neovascular membrane around the optic disc.
MCP can exist for many years. Many patients may have recurrent episodes of monocular or binocular. Recurrent inflammation often manifests as peripheral edema of anterior chamber and vitreous inflammation or choroidal scar. Occasionally new lesions appear. Repeated episodes often affect vision. And easy to induce choroidal neovascular membrane formation.
Examine
Multifocal choroiditis with a review of total uveitis
1. Fluorescein fundus angiography: It can show that there is no abnormal fluorescence or weak fluorescence in the early stage of active disease, and then gradually appear staining and leakage; atrophic lesions show window-like defects, and in some patients, optic disc fluorescein can still be found. Leakage, cystoid macular edema, etc.
2. Indocyanine green angiography: multiple strong fluorescence areas can be found in the pole after the active period of the lesion. The number of lesions found is greater than the number of lesions found in fluorescein fundus angiography and ophthalmoscopy; after the lesion subsides Multiple weak fluorescent areas appear.
3. Visual field examination: visual field examination can reveal the expansion of physiological blind spots. In some patients, central vision, peripheral central visual field and peripheral visual field abnormalities may also occur, but these abnormalities are generally not characteristic.
Diagnosis
Multi-focal choroiditis with diagnosis of total uveitis
The diagnosis of this disease is mainly based on typical multifocal choroiditis with mild to moderate anterior chamber and vitreous inflammatory response, fluorescein fundus angiography, indocyanine green angiography, and visual field examination are helpful for diagnosis.
Differential diagnosis
1. DSF and PIC: also in young women, for the deep retina, RPE and choroid multiple yellow spotted inflammation, can lead to the formation of choroidal scars in the choroidal retina, but the former seems to be the late performance of MCP, and then It may be a mild MCP. If the three are considered as independent diseases, unlike MCP, DSF may have obvious fibrotic changes under the retina in the later stage, while PIC lacks inflammation of the anterior chamber and vitreous. And the fundus lesions showed strong fluorescence in the early stage of fluorescein angiography.
2. Eye-like tissue cytoplasmic syndrome: fundus manifestations are very similar to MCP, but no anterior chamber and vitreous inflammatory manifestations, patients without gender differences, patients with a history of tissue cytoplasmic disease in the area of disease or positive tissue In the cytoplasmin skin test, visual field changes in physiological blind spots were rare.
3. Shotgun-like retinal choroidal lesions: more common in the elderly and mostly HLA-A29 phenotype, the lesion lacks pigmented scars like MCP.
4. Multiple transient white point syndrome: The course of the disease is short, the lesion is located in the outer retina, white and light, and generally does not form choroidal scar.
5. Acute posterior multifocal squamous pigment epithelial lesions: There is no inflammation in the anterior segment of the eye. In some patients, vitreous inflammatory cells can be seen. The fundus lesions are large and diverse in shape, and there is no recurrence after the lesions heal.
