一过性白点综合征多模态检测特征的临床研究

doi:10.3877/cma.j.issn.2095-2007.2026.01.005

目的

探讨多发性一过性白点综合征(MEWDS)多模态影像检测的临床特征、预后及各检测手段的应用价值。

方法

选取2018年1月至2019年6月在云南省第二人民医院眼科确诊的MEWDS患者18例(18只眼)作为研究对象。其中，男性3例(3只眼)，女15例(15只眼)；年龄19~36岁，平均年龄(27.7±4.3)岁。所有患者均接受最佳矫正视力、眼底彩色照相(FP)、眼底自发荧光(FAF)、荧光素眼底血管造影(FFA)、脉络膜吲哚菁绿血管造影(ICGA)、超广角眼底彩色照相(UWF-FP)、超广角眼底自发荧光(UWF-FAF)及光学相干断层扫描(OCT)检查。所有患者定期随访。记录各检测设备不同模态在初诊及随访各阶段患者的病灶检出率、数量、清晰度及病变范围等方面的特征。患者年龄采用±s描述；预后效果占比采用频数和百分比(%)描述。

结果

18例(18只眼)患者FP、UWF-FP、FAF、UWF-FAF、FFA、ICGA及OCT影像病灶检出MEWDS 16例(16只眼)、18例(18只眼)、18例(18只眼)、18例(18只眼)、18例(18只眼)、18例(18只眼)及18例(18只眼)；检出率分别为88.9%、100.0%、100.0%、100.0%、100.0%、100.0%及100.0%。18例(18只眼)FAF及UWF-FAF对病灶的显示优于同眼FP及UWF-FP。2例(2只眼)轻型患者FP仅见2~3个边界模糊斑点，FAF成像可清晰显示多个高自发荧光；16例(16只眼)重型患者FAF及UWF-FAF所示病灶数量均多于FP及UWF-FP。18例(18只眼)FAF病灶数量均多于FFA。16例(16只眼)FAF高自发荧光与ICGA晚期低荧光斑点基本对应。随访8~16周内，18例(18只眼)UWF-FAF高自发荧光逐渐消退，病灶完全消退时间平均(12.3±2.1)周，UWF-FAF对周边残余病灶的监测优于UWF-FP。根据随访2个月最佳矫正视力是否≥0.5分为预后不佳者4例(4只眼)和预后良好者14例(14只眼)，分别占22.2%和77.8%。预后不佳者首诊FAF均显示高自发荧光累及黄斑中心凹，中心凹低自发荧光区消失，OCT示椭圆体带紊乱；治疗后中心凹低自发荧光区及椭圆体带难以完全恢复。预后良好者首诊UWF-FAF高自发荧光未累及中心凹，治疗后病灶消退，椭圆体带结构恢复正常。

结论

FAF及UWF-FAF对MEWDS病灶的敏感度最高，病灶数量和清晰度均优于FP及FFA，与ICGA晚期低荧光对应性更好。首诊FAF高自发荧光是否累及黄斑中心凹是重要的预后预测指标。UWF-FP成像在随访监测中具有显著优势。

关键词: 多发性一过性白点综合征, 眼底自发荧光, 超广角眼底成像, 多模态影像, 预后

Objective

The aim of this study is to investigate the multimodal imaging characteristics of multiple evanescent white-dot syndrome (MEWDS) and evaluate the clinical value of each imaging modality.

Methods

A total of 18 patients (18 eyes) with clinically confirmed MEWDS at the Department of Ophthalmology, the Second People′s Hospital of Yunnan Province, between January 2018 and June 2019 were enrolled. Among them, there were 3 male (3 eyes) and 15 female (15 eyes) with a mean age of (27.7±4.3) years (rangingfrom 19 to 36 years). All patients underwent best-corrected visual acuity (BCVA), fundus photography (FP), fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), ultra-widefield fundus photography (UWF-FP), ultra-widefield fundus autofluorescence (UWF-FAF), and optical coherence tomography (OCT) examinations. Regular follow-up was performed for 8 to 16 weeks. The differences among modalities in lesion number, clarity, and extent were compared, as well as their value in diagnosis, follow-up, and prognostic evaluation.

Results

Among the 18 patients (18 eyes), lesions were detected by FP, UWF-FP, FAF, UWF-FAF, FFA, ICGA, and OCT in 16 (16 eyes), 18 (18 eyes), 18 (18 eyes), 18 (18 eyes), 18 (18 eyes), 18 (18 eyes), and 18 (18 eyes), respectively, corresponding to detection rates of 88.9%, 100.0%, 100.0%, 100.0%, 100.0%, 100.0%, and 100.0%. FAF or UWF-FAF outperformed FP or UWF-FP in lesion visualization in all 18 eyes (100.0%). In 2 eyes with mild disease, FP revealed only 2 to 3 poorly demarcated spots, whereas FAF clearly displayed multiple hyperautofluorescent foci. In 16 eyes with severe disease, FAF or UWF-FAF demonstrated more lesions than FP or UWF-FP. FAF detected more lesions than FFA in all 18 eyes. In 16 eyes, hyperautofluorescent spots on FAF generally corresponded to late-phase hypofluorescent spots on ICGA. During follow-up, the hyperautofluorescence on UWF-FAF gradually faded in all 18 eyes, with a mean complete resolution time of (12.3±2.1) weeks; UWF-FAF was superior to UWF-FP in monitoring residual peripheral lesions. Regarding prognosis, 4 cases (4 eyes) in the poor-prognosis group showed hyperautofluorescence involving the foveal center with loss of the foveal hypoautofluorescent zone on initial FAF, and ellipsoid zone disruption on OCT; after treatment, neither the foveal hypoautofluorescent zone nor the ellipsoid zone fully recovered. In contrast, 14 cases (14 eyes) in the good-prognosis group showed initial FAF hyperautofluorescence sparing the foveal center, with lesion resolution and normalization of the ellipsoid zone after treatment.

Conclusions

FAF and UWF-FAF demonstrate the highest sensitivity for detecting MEWDS lesions, outperforming FP and FFA in both lesion count and clarity, and showing the closest correspondence with late-phase hypofluorescent spots on ICGA. Foveal involvement by hyperautofluorescence on initial FAF serves as an important prognostic predictor, and UWF-FP imaging offers a clear advantage in follow-up monitoring.

Key words: Multiple evanescent white-dot syndrome, Fundus autofluorescence, Ultra-widefield imaging, Multimodal imaging, Prognosis

表1 18例多发性一过性白点综合征患者各模态影像病灶检出及显示特征情况

检查项目	检出病灶(只眼)	检出率(%)	病灶显示特征
眼底彩色照相	16	88.9	黄白色斑点，边界模糊，轻型患者部分无法显示
超广角眼底照相	18	100.0	范围广，可见周边病灶，但斑点边界仍欠清晰
眼底自发荧光	18	100.0	高自发荧光，边界清晰，病灶数量多于眼底彩色照相及荧光素眼底血管造影
超广角自发荧光	18	100.0	清晰显示后极至周边全范围病灶，敏感度最高
荧光素眼底血管造影	18	100.0	斑点状高荧光，无明显渗漏，数量少于眼底自发荧光
吲哚菁绿血管造影	18	100.0	晚期低荧光斑，与眼底自发荧光高荧光对应性好
光学相干断层扫描	18	100.0	椭圆体带结构改变，反映感光细胞损伤程度

表1 18例多发性一过性白点综合征患者各模态影像病灶检出及显示特征情况

检查项目	检出病灶(只眼)	检出率(%)	病灶显示特征
眼底彩色照相	16	88.9	黄白色斑点，边界模糊，轻型患者部分无法显示
超广角眼底照相	18	100.0	范围广，可见周边病灶，但斑点边界仍欠清晰
眼底自发荧光	18	100.0	高自发荧光，边界清晰，病灶数量多于眼底彩色照相及荧光素眼底血管造影
超广角自发荧光	18	100.0	清晰显示后极至周边全范围病灶，敏感度最高
荧光素眼底血管造影	18	100.0	斑点状高荧光，无明显渗漏，数量少于眼底自发荧光
吲哚菁绿血管造影	18	100.0	晚期低荧光斑，与眼底自发荧光高荧光对应性好
光学相干断层扫描	18	100.0	椭圆体带结构改变，反映感光细胞损伤程度

图1　病变较轻多发性一过性白点综合征患者的眼底影像　图1A示眼底照相，可见黄斑周少许欠清的2~3个黄白色斑点，边界模糊；图1B示眼底自发荧光，可见黄斑周多个散在的斑状高自发荧光影，边界尚清，大小不等，显示的斑点较眼底照相中的斑点数量多　图2　病变较重多发性一过性白点综合征患者的眼底影像　图2A示眼底自发荧光成像，可见后极部大量斑点状或花环状高自发荧光，集中于黄斑区及视盘周围，边界尚清，大小不等，视盘周高自发荧光相互融合呈大片状高自发荧光；图2B示荧光素眼底血管造影，可见后极部散在大量斑点状高荧光，无明显荧光渗漏，边界模糊，视盘周高荧光相互融合呈片状高荧光影；图2C示晚期时脉络膜吲哚菁绿血管成像，可见后极部大量散在斑点状或花环状低荧光，边界尚清，大小不等，集中于黄斑区及视盘周围，视盘周低荧光相互融合成大片低荧光　图3　多发性一过性白点综合征患者不同时期的眼底影像　图3A和图3B分别示患者初诊时超广角眼底照相和超广角眼底自发荧光，前者显示后极部散在灰白色斑点，大小不等，边界不清，向周边视网膜延伸，部分融合，病灶清晰度较低；后者显示后极部大量散在斑点状或花环状的高自发荧光，大小不等，向周边视网膜延伸，视盘及黄斑周的高自发荧光相互融合成大片状高自发荧光影；图3C和图3D分别示患者随访过程中超广角眼底照相和超广角眼底自发荧光，前者可见斑点逐渐减少，不清晰，难以发现，仅见周边视网膜少许灰白色斑点灰白色；后者可见后极部有所减弱的高自发荧光及斑点状或花环状高自发荧光大片相互融合，斑点数量较之前明显减少；图3E和图3F分别示患者末次随访的超广角眼底照相和超广角眼底自发荧光，前者可见眼底完全正常，未见明显灰白色斑点；后者可见自发荧光完全正常，未见明显斑点状高自发荧光影

图4　预后不佳多发性一过性白点综合征患者不同时期的眼底影像　图4A和图4B分别示患者初诊和治疗后超广角眼底自发荧光，初诊时可见黄斑中心凹区域被强自发荧光的白色斑点覆盖，中心凹低自发荧光区域消失；治疗后可见中央及周边强自发荧光点减弱消失，但黄斑中心低自发荧光区域恢复不佳；图4C和图4D分别示患者初诊和治疗后光学相干断层扫描成像，初诊时可见中心凹区域椭圆体结构紊乱；治疗后可见椭圆体带结构有所恢复，但仍未形成光滑的线样结构　图5　预后良好多发性一过性白点综合征患者不同时期的眼底影像　图5A和图5B分别示患者初诊和治疗后超广角眼底自发荧光，初诊时可见后极及周边部点状高自发荧光、中心凹低自发荧光区域未被累及；治疗后可见中央及周边强自发荧光点减弱消失，黄斑中心低自发荧光区域维持良好；图5C和图5D分别示患者初诊和治疗后光学相干断层扫描成像，初诊时可见中心凹区域椭圆体线样结构稍模糊；治疗后可见椭圆体带结构恢复成光滑的线样结构

[1]	Gross NE, Yannuzzi LA, Freund KB, et al. Multiple evanescent white dot syndrome[J]. Arch Ophthalmol, 2006, 124(4): 493-500.
[2]	Jampol LM, Sieving PA, Pugh D, et al. Multiple evanescent white dot syndrome. I. Clinical findings[J]. Arch Ophthalmol, 1984, 102(5): 671-674.
[3]	Meng Y, Zhang Q, Li L, et al. Primary multiple evanescent white dot syndrome and multiple evanescent white dot syndrome secondary to multifocal choroiditis/punctate inner choroidopathy: a comparative study[J]. Retina, 2023, 43(7): 1122-1131.
[4]	Chen C, Cheng Y, Zhang Z, et al. Multifocal evanescent white dot syndrome-like phenotypes associated with inflammatory and myopic choroidal neovascularization[J]. BMC Ophthalmol, 2024, 24(1): 3.
[5]	魏文斌，陈积中. 眼底病鉴别诊断学[M]. 北京：人民卫生出版社，2012: 405.
[6]	Dell'omo R, Wong R, Marino M, et al. Relationship between different fluorescein and indocyanine green angiography features in multiple evanescent white dot syndrome[J]. Br J Ophthalmol, 2010, 94(1): 59-63.
[7]	Sikorski BL, Wojtkowski M, Kaluzny JJ, et al. Correlation of spectral optical coherence tomography with fluorescein and indocyanine green angiography in multiple evanescent white dot syndrome[J]. Br J Ophthalmol, 2008, 92(11): 1552-1557.
[8]	Munk MR, Stillenmunkes R, Tillmann A, et al. Evidence and consensus based imaging guidelines in multiple evanescent white dot syndrome-Multimodal imaging in Uveitis (MUV) Taskforce Report 6[J]. Am J Ophthalmol, 2025, 278: 191-202.
[9]	Chen CL, Cheng YZ, Zhang ZH, et al. Clinical features and possible pathogenesis of multiple evanescent white dot syndrome with different retinal diseases and events: a narrative review[J]. Int J Ophthalmol, 2024, 17(3): 583-595.
[10]	Cicinelli MV, Ramtohul P, Marchese A, et al. Latest advances in white spot syndromes: new findings and interpretations[J]. Prog Retin Eye Res, 2023, 97: 101207.
[11]	Yzer S, Freund KB, Engelbert M. Imaging in the diagnosis and management of acute macular neuroretinopathy[J]. Int Ophthalmol Clin, 2012, 52(4): 269-273.
[12]	Liu ZY, Zhang H, Sun XL. Multiple evanescent white dot syndrome and presentations similar to multiple evanescent white dot syndrome in other disorders: a narrative review[J]. Int J Ophthalmol, 2025, 18(9): 1777-1789.
[13]	Salameti A, Eidet JR. Bilateral multiple evanescent white dot syndrome documented and followed by swept-source OCT angiography: a case report[J]. J Ophthalmic Inflamm Infect, 2025, 15(1): 78.
[14]	Feo A, Sarraf D. En face optical coherence tomography and OCT angiography in the pathoanatomy of inflammatory macular disease[J]. Am J Ophthalmol, 2026, 284: 110-122.
[15]	Harada S, Kato K, Matsui Y, et al. Multiple evanescent white dot syndrome in highly myopic eye in which fundus autofluorescence was diagnostically useful: a case report[J]. Medicine (Baltimore), 2023, 102(5): e32713.
[16]	Gaudric A, Mrejen S. Why the dots are black only in the late phase of the indocyanine green angiography in multiple evanescent white dot syndrome[J]. Retina Cases Brief Rep, 2017, 11: S81-S88.
[17]	Furino C, Boscia F, Cardascia N, et al. Fundus autofluorescence and multiple evanescent white dot syndrome[J]. Retina, 2009, 29(1): 60-63.
[18]	Marsiglia M, Gallego-Pinazo R, Cunha de Souza E, et al. Expanded clinical spectrum of multiple evanescent white dot syndrome with multimodal imaging[J]. Retina, 2016, 36(1): 64-74.
[19]	Serrar Y, Kodjikian L, Mathis T. Topographic patterns of retinal lesions in multiple evanescent white dot syndrome[J]. Graefes Arch Clin Exp Ophthalmol, 2024, 262(1): 357-359.
[20]	Chen N, Mandell M, Arjmand P. Multimodal imaging findings of multiple evanescent white dot syndrome in COVID-19 patients[J]. IDCases, 2024, 38: e02110.
[21]	Ting M, Hsueh J, Noori J. Multiple evanescent white dot syndrome associated with COVID-19 infection: a case report[J]. J Med Case Rep, 2024, 18(1): 272.
[22]	Ng HW, Niederer RL. Lightning can strike twice: recurrent multiple evanescent white dot syndrome (MEWDS) following both COVID-19 vaccination and subsequent COVID-19 infection[J]. J Ophthalmic Inflamm Infect, 2023, 13(1): 36.
[23]	Gallo B, Talks JS, Pandit RJ, et al. Multiple evanescent white dot syndrome and choroidal neovascularization following SARS-COV-2 infection in a patient on dabrafenib and trametinib[J]. Ocul Immunol Inflamm, 2023, 31(3): 641-648.
[24]	Song YY, Kim JT, Chang YS, et al. Increased incidence and diverse manifestations of multiple evanescent white dot syndrome during the COVID-19 pandemic[J]. Sci Rep, 2024, 14(1): 12425.
[25]	周才喜，刘立民，毛爱玲. 多发性一过性白点综合征的自发荧光观察[J]. 中华眼科杂志，2013，49(12)：1089-1093.
[26]	Chandrasekaran PR, Chan HH, Tan TE, et al. A case of secondary multiple evanescent white dot syndrome in a patient with preexisting wet age-related macular degeneration[J]. Am J Ophthalmol Case Rep, 2024, 34: 102016.
[27]	Enríquez-Fuentes JE, Cuba-Sulluchuco FK, Donate-López J, et al. Multiple evanescent white dot syndrome (MEWDS) secondary to acute retinal pigment epitheliitis: possible atypical presentation of MEWDS？[J]. Ocul Immunol Inflamm, 2025, 33(3): 482-484.
[28]	Touhami S, Chung YR, March F, et al. Atypical mid-late phase ICGA hyperfluorescence in a secondary MEWDS case: a distinct disease or a shift in our understanding of MEWDS？[J]. Ocul Immunol Inflamm, 2025. PMID: 2493363.

[1]	叶秀华, 邵莉滨, 李群星, 叶剑涛. 套筒冠义齿基牙5年存留率及其预后因素的回顾性研究[J/OL]. 中华口腔医学研究杂志(电子版), 2026, 20(02): 126-131.
[2]	曹喆, 翁桂湖, 刘涛, 张锰钢, 杨刚, 陈浩, 邱江东, 徐建威, 张太平. 新型预后营养炎症评分系统建立以有效预测胰腺癌根治术后患者的长期预后[J/OL]. 中华普通外科学文献(电子版), 2026, 20(02): 85-90.
[3]	邓励旺, 黄予希, 刘施沂, 李彬. 肝内胆管癌中三级淋巴结构及其他病理特征对预后的影响[J/OL]. 中华普通外科学文献(电子版), 2026, 20(02): 91-97.
[4]	付丽坤, 崔红梅, 高福来, 乔红, 冯钟煦. 腹腔镜下胆总管探查“T”管引流术与经胆囊管胆总管探查取石术治疗继发性胆总管结石的疗效对比[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(03): 226-230.
[5]	辛林璞, 杨敏, 杜峻峰. 腹腔镜结直肠癌根治术后常见并发症防治与管理[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(03): 248-251.
[6]	樊伟伟, 许怀利, 杨喜佳. 中间入路与左侧前入路在中老年进展期胃癌腹腔镜根治术中的应用对比[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(02): 117-120.
[7]	甘志新, 胡雍军, 杨倩, 胡明冬. 75例急性呼吸窘迫综合征的临床特征及预后分析[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(02): 221-226.
[8]	张金, 叶强, 姚淳, 许金凤, 郑礼杰. 血清钙卫蛋白水平动态变化与重症肺炎患者预后的相关性分析[J/OL]. 中华肺部疾病杂志(电子版), 2026, 19(02): 275-281.
[9]	邓玉飞, 王志鑫, 娄珂, 张林轩, 马桂春, 港措. 影像组学在肝癌精准诊断、疗效评估及治疗方案决策优化中应用[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 172-180.
[10]	吴杰嵘, 严庆, 胡健垣, 陈焕伟. 复发性肝细胞癌再次手术切除与射频消融临床疗效比较[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 211-218.
[11]	张雨霄, 潘怡, 邱田, 邹霜梅. 行二代测序结直肠癌患者cMET的表达水平与临床病理特征和分子特征的相关性及预后价值的研究[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(02): 122-132.
[12]	温钰, 张尊庶, 丁泽浩, 郑仁杰, 武宾, 孙海翔, 韩超, 黄陈. 基于淋巴结转移的结直肠癌新分期与预后关系[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(02): 133-145.
[13]	王欢, 王伟彪, 李多, 于永强, 武雪亮, 樊建春. 基于溶酶体相关基因构建结直肠癌预后模型的研究[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(02): 146-159.
[14]	向健, 刘莉. 血清IL-1、PAF与急性大出血合并输血相关性急性肺损伤患者预后不良的关系[J/OL]. 中华临床实验室管理电子杂志, 2026, 14(02): 134-140.
[15]	单子恒, 王帆, 马丽, 张涛, 邵丽. 头颈部CT血管成像联合头颅CT灌注成像评估急性缺血性脑卒中患者短期预后的效能[J/OL]. 中华脑血管病杂志(电子版), 2026, 20(02): 164-169.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

The multimodal imaging features of multiple evanescent white dot syndrome

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

The multimodal imaging features of multiple evanescent white dot syndrome