White spot syndromes of the retina: a hypothesis based on the common genetic hypothesis of autoimmune/inflammatory disease

Abstract

Ophthalmologists treating patients with retinal disease are faced with a number of inflammatory diseases of unknown etiology, including multifocal choroiditis with panuveitis (MFC), punctate inner choroidopathy (PIC), multiple evanescent white dot syndrome (MEWDS), acute zonal occult outer retinopathy (AZOOR), acute macular neuroretinopathy, acute posterior multifocal placoid pigment epitheliopathy (APMPPE), serpiginous choroidopathy, and relentless placoid chorioretinopathy. For some of these entities, an infectious cause has been suggested based upon suspected or documented infections (usually “viral”). For example, MEWDS has been reported after varicella infection 1 McCollum C.J. Kimble J.A. Peripapillary subretinal neovascularization associated with multiple evanescent white-dot syndrome. Arch Ophthalmol. 1992; 110: 13-15 Crossref PubMed Scopus (26) Google Scholar and APMPPE after adenovirus infection. 2 Azar Jr, P. Gohd R.S. Waltman D. Gitter K.A. Acute posterior multifocal placoid pigment epitheliopathy associated with an adenovirus type 5 infection. Am J Ophthalmol. 1975; 80: 1003-1005 Abstract Full Text PDF PubMed Scopus (59) Google Scholar Conversely, immune causes have also been suggested based upon precipitation of the “syndrome” by vaccination (for example, MEWDS, 3 Baglivo E. Safran A.B. Borruat F.X. Multiple evanescent white dot syndrome after hepatitis B vaccine. Am J Ophthalmol. 1996; 122: 431-432 Abstract Full Text PDF PubMed Scopus (61) Google Scholar APMPPE 4 Brezin A.P. Massin-Korobelnik P. Boudin M. Gaudric A. LeHoang P. Acute posterior multifocal placoid pigment epitheliopathy after hepatitis B vaccine. Arch Ophthalmol. 1995; 113: 297-300 Crossref PubMed Scopus (69) Google Scholar ) or responses to immunosuppressive medications (multifocal choroiditis, serpiginous choroiditis). Yet, for all of these entities, autoimmune or infectious causes have been sought without consistent believable evidence to date.