Evolution of Concepts About White Dot Syndromes (Literature Review)
Abstract
Several non-infectious posterior uveitis with similar clinical manifestations were grouped under the name «white dot syndromes» (WDS) more than fifty years ago and continue to be actively studied. On the one hand, today quite a lot is known about these diseases, and on the other hand, the expansion of diagnostic capabilities and the use of multimodal imaging have contributed to a significant transformation of ideas about WDS. According to current concepts, most WDS are primary choriocapillaritis, and the results of a number of studies demonstrate that each syndrome is a unique entity. At the same time, some authors believe that the term «white dot syndromes» has lost its relevance, and clinicians are discussing a revision of the WDS classification.
About the Authors
E. V. Bobykin
ФГБОУ ВО «Уральский государственный медицинский университет» Минздрава России
Russian Federation
Russian Federation
A. N. Mineeva
ФГБОУ ВО «Уральский государственный медицинский университет» Минздрава России
Russian Federation
Russian Federation
References
1. Abu-Yaghi N.E. [et al.] White dot syndromes: A 20-year study of incidence, clinical features, and outcomes. Ocul. Immunol. Inflamm. 2011;19(6):426–430. (in Engl). DOI: 10.3109/09273948.2011.624287.
2. Cicinelli M.V. [et al.] Latest advances in white spot syndromes: New findings and interpretations [Electronic resource]. Prog. Retin. Eye Res. 2023;97. URL: https://www.sciencedirect.com/science/article/abs/pii/S1350946223000460?via%3Dihub (accessed 10 February 2025). (in Engl). DOI: 10.1016/j.preteyeres.2023.101207.
3. Marchese A. [et al.] Placoid lesions of the retina: progress in multimodal imaging and clinical perspective. Br. J. Ophthalmol. 2022;106(1):14–25. (in Engl). DOI: 10.1136/bjophthalmol-2020-318337.
4. Mount G.R., Kaufman E.J. White Dot Syndromes [Electronic resource] StatPearls, 2024. URL: https://www.ncbi.nlm.nih.gov/books/NBK557854/ (accessed 10 February 2025). (in Engl).
5. Forrester J.V. [et al.] Posterior segment intraocular inflammation: guidelines. Amsterdam: Kugler Publications. 1998:215 p. (in Engl).
6. Buggage R. White dot syndromes. Focal Points: Clinical Modules for Ophthalmologists. San Francisco: American Academy of Ophthalmology. 2007;25(4). (in Engl).
7. Neri P. [et al.] “White dot syndromes”, an inappropriate and outdated misnomer. Int. Ophthalmol. 2022;42(1):1–6. (in Engl). DOI: 10.1007/s10792-021-02121-4.
8. Gass J.D. Acute posterior multifocal placoid pigment epitheliopathy. Arch. Ophthalmol. 1968;80(2):177–185. (in Engl). DOI: 10.1001/archopht.1968.00980050179005.
9. Ryan S.J., Maumenee A.E. Birdshot retinochoroidopathy. Am. J. Ophthalmol. 1980;89(1):31–45. (in Engl). DOI: 10.1016/0002-9394(80)90226-3.
10. Jampol L.M. [et al.] Multiple evanescent white dot syndrome. Arch. Ophthalmol. 1984;102(5):671–674. (in Engl). DOI: 10.1001/archopht.1984.01040030527008.
11. Dreyer R.F., Gass J.D. Multifocal choroiditis and panuveitis. A syndrome that mimics ocular histoplasmosis. Arch. Ophthalmol. 1984;102:1776–1784. (in Engl). DOI: 10.1001/archopht.1984.01040031440019.
12. Watzke [et al.] R.C. Punctate inner choroidopathy. Am. J. Ophthalmol. 1984;98(5):572–584. (in Engl). DOI: 10.1016/0002-9394(84)90243-5.
13. Gass J.D. Acute zonal occult outer retinopathy. Donders Lecture: The Netherlands Ophthalmological Society, Maastricht, Holland, June 19, 1992. J. Clin. Neuroophthalmol. 1993;13(2):79–97. (in Engl).
14. Quillen D.A. [et al.] The white dot syndromes. Am. J. Ophthalmol. 2004;137(3):538–550. (in Engl). DOI: 10.1016/j.ajo.2004.01.053.
15. Crawford C.M., Igboeli O.Review of the inflammatory chorioretinopathies: the white dot syndromes. ISRN Inflamm. 2013:1–9. (in Engl).
16. Martidis A., Duker J.S., Puliafito C.A. Intravitreal triamcinolone for refractory cystoid macular edema secondary to birdshot retinochoroidopathy. Arch. Ophthalmol. 2001;119(9):1380–1383. (in Engl).
17. Levinson R.D., Gonzales C.R. Birdshot retinochoroidopathy: immunopathogenesis, evaluation, and treatment. Ophthalmol. Clin. North. Am. 2002;15(3):343–350. (in Engl). DOI: 10.1016/S0896-1549(02)00031-7.
18. Jabs D.A. Immunosuppression for the uveitides. Ophthalmology. 2018; 125(2):193–202. (in Engl). DOI: 10.1016/j.ophtha.2017.08.007.
19. Akpek E.K. [et al.] Successful treatment of serpiginous choroiditis with alkylating agents. Ophthalmology. 2002;109(8):1506–1513. (in Engl).
20. Rouvas A. [et al.] Intravitreal ranibizumab for the treatment of inflammatory choroidal neovascularization. Retina. 2011;31(5):871–879. (in Engl). DOI: 10.1097/IAE.0b013e3182003ca8.
21. Spaide R.F. [et al.] Treatment of subfoveal choroidal neovascularization associated with multifocal choroiditis and panuveitis with photodynamic therapy / // Retina. 2002;22(5):545–549. (in Engl). DOI: 10.1097/00006982-200210000-00003.
22. Spaide R.F., Sorenson J., Maranan L. Combined photodynamic therapy and intravitreal triamcinolone for nonsubfoveal choroidal neovascularization. Retina. 2005;25(6):685–690. (in Engl). DOI: 10.1097/00006982-200509000-00001.
23. Shantha J.G. [et al.] Choroidal neovascularization associated with birdshot chorioretinopathy / // Ophthalmic Surg Lasers Imaging Retina. 2016;47(5):450–457. (in Engl). DOI: 10.3928/23258160-20160419-08.
24. Pohlmann D., Winterhalter S., Pleyer U. White dot syndromes: principles, diagnostics, and treatment. Ophthalmologe. 2019;116(12):1235–1256. (in German). DOI: 10.1007/s00347-019-01012-5.
25. Krill A.E., Deutman A.F. Acute retinal pigment epitheliitus. Am. J. Ophthalmol. 1972;74(2):193–205. (in Engl). DOI: 10.1016/0002- 9394(72)90535-1.
26. Fiore T. [et al.] Acute posterior multifocal placoid pigment epitheliopathy: outcome and visual prognosis. Retina. 2009;29(7):994–1001. (in Engl). DOI: 10.1097/IAE.0b013e3181a0bd15.
27. Hangai M., Fujimoto M., Yoshimura N. Features and function of multiple evanescent white dot syndrome. Arch. Ophthalmol. 2009;127(10):1307–1313. (in Engl). DOI: 10.1001/archophthalmol.2009.250.
28. Michel S.S. [et al.] Multifocal choroiditis and panuveitis: immunomodulatory therapy. Ophthalmology. 2002;109(2):378–383. (in Engl). DOI: 10.1016/S0161-6420(01)00901-0.
29. Thorne J.E. [et al.] Birdshot retinochoroidopathy: ocular complications and visual impairment. Am. J. Ophthalmol. 2005;140(1):P. 45– 51. (in Engl). DOI: 10.1016/j.ajo.2005.01.035.
30. Nazari Khanamiri H., Rao N.A. Serpiginous Choroiditis and infectious multifocal serpiginoid choroiditis. Surv. Ophthalmol. 2013;58(3):203–232. (in Engl). DOI: 10.1016/j.survophthal.2012.08.008.
31. Dunn J.P. Imaging in the white dot syndromes. Int. Ophthalmol. Clin. 2016;56(4):175-201. (in Engl). 32. van Grinsven M. J. J. P. [et al.] Automatic identification of reticular pseudodrusen using multimodal retinal image analysis. Invest. Ophthalmol. Vis. Sci. 2015;56(1):633-639. (in Engl). DOI: 10.1167/iovs.14-15019.
32. Spaide R.F., Goldberg N., Freund K.B. Redefining multifocal choroiditis and panuveitis and punctate inner choroidopathy through multimodal imaging. Retina. 2013;33(7):1315-1324. (in Engl). DOI: 10.1097/IAE.0b013e318286cc77.
33. Smith W.M. [et al.] 2024-2025 Basic and Clinical Science Course, Section 9: Uveitis and Ocular Inflammation. San Francisco: American Academy of Ophthalmology, 2024:168–171. (in Engl).
34. Herbort C.P. [et al.] Classification of non-infectious and/or immune mediated choroiditis: A brief overview of the essentials [Electronic resource]. Diagnostics. 2021;11(6). URL: https://www.mdpi.com/2075-4418/11/6/939 (accessed 7 February 2025). (in Engl).
35. Herbort C.P., LeHoang P., Guex-Crosier Y. Schematic interpretation of indocyanine green angiography in posterior uveitis using a standard angiographic protocol. Ophthalmology. 1998;105(3):432–440. (in Engl). DOI: 10.1016/S0161-6420(98)93024-X.
36. Spaide R.F., Koizumi H., Pozonni M.C. Enhanced depth imaging spectral-domain optical coherence tomography. Am. J. Ophthalmol. 2008;146(4):496–500. (in Engl). DOI: 10.1016/j.ajo.2008.05.032.
37. Tummala G.C. [et al.] Swept source OCTA reveals a link between choriocapillaris blood flow and vision loss in a case of tubercular serpiginous-like choroiditis [Electronic resource]. Am. J. Ophthalmol. Case Rep. 2021;21. URL: https://www.sciencedirect.com/science/article/pii/S2451993621000098?via%3Dihub (accessed 5 February 2025). (in Engl).
38. Mebsout-Pallado C. [et al.] Review of the current literature and our experience on the value of OCT-angiography in white dot syndromes. Ocul. Immunol. Inflamm. 2022;30(2):364–378. (in Engl). DOI: 10.1080/09273948.2020.1837185.
39. Raven M.L. [et al.] Multi-modal imaging and anatomic classification of the white dot syndromes [Electronic resource]. Int. J. Retina Vitreous. 2017;3(12). URL: https://journalretinavitreous.biomedcentral.com/articles/10.1186/s40942-017-0069-8#citeas (accessed 1 February 2025). (in Engl). DOI: 10.1186/s40942-017-0069-8.
40. Fabiani C. [et al.] Is it time to adopt a new nomenclature and classification for white dot syndromes using multimodal imaging techniques? Report 1 from multimodal umaging in uveitis (MUV) task force. Ocul. Immunol. Inflamm. 2024:1–9. (in Engl). DOI: 10.1080/09273948.2024.2423870.
41. Gass J.D., Agarwal A., Scott I.U. Acute zonal occult outer retinopathy: a long-term follow-up study. Am. J. Ophthalmol. 2002;134(3):329–339. (in Engl). DOI: 10.1016/S0002-9394(02)01640-9.
42. Jampol L.M., Wiredu A.MEWDS, MFC, PIC, AMN, AIBSE, and AZOOR: one disease or many? Retina. 1995;15(5):373–378. (in Engl).
43. Mrejen S. [et al.] Acute zonal occult outer retinopathy: a classification based on multimodal imaging. JAMA Ophthalmol. 2014;132(9):1089–1098. (in Engl). DOI: 10.1001/jamaophthalmol.2014.1683.
44. Taira K. [et al.] Acute zonal occult outer retinopathy in the fellow eye 5 years after presentation of punctate inner choroidopathy. Graefes Arch. Clin. Exp. Ophthalmol. 2006;244(7):880–882. (in Engl). DOI: 10.1007/s00417-005-0172-7.
45. Gilbert R.M. [et al.] Differentiating multifocal choroiditis and punctate inner choroidopathy: a cluster analysis approach. Am. J. Ophthalmol. 2020;213:244-251. (in Engl). DOI: 10.1016/j.ajo.2020.01.031.
46. Park J.G. [et al.] Distinct patterns of choroidal lesions in punctate inner choroidopathy and multifocal choroiditis determined by heatmap analysis. Ocul. Immunol. Inflamm. 2022;30(2):276-281. (in Engl). DOI: 10.1080/09273948.2021.1939391.
Review
For citations:
Bobykin E.V., Mineeva A.N. Evolution of Concepts About White Dot Syndromes (Literature Review). Bashkortostan Medical Journal. 2025;20(2):77-83. (In Russ.)
Views:
5
Email this article 
