ABSTRACT
We examined three patients with multiple evanescent white dot syndrome(MEWDS) using confocal laser scanning indocyanine green angiography(ICGA), and observed two types of hypofluorescent lesion which were very characteristic and diagnostic by themselves. One was dot pattern, dense hypofluorescences which were detected evidently in the late phases, and some of them could be confirmed in the early phases. They clustered in the peripapillary area and dispersed sporadically to the midperiphery. The other was circular pattern, relatively lighter hypofluorescences which were evidently observed in the late phases also. They were crowded and fused in the peripapillary area or in the posterior pole and scattered to the midperiphery in a radiating pattern. These area included clinically observed white dot lesions, but were more widespread distinctively. At the recovery stages, all these hypofluorescent lesions disappeared completely. It is supposed that the former represents blocked fluorescence by inflammatory precipitates and the latter reveals circulatory disturbance in the choriocapillary or pre-capillary arteriole. Previous fluorescein angiographic and electrophysiologic studies have demonstrated the involvement of the retinal pigment epithelium(RPE) and photoreceptors in MEWDS. Our findings on ICGA suggest that the ischemic choroidal circulatory disturbance due to the inflammatory precipitates in the choroid may be the primary change and the RPE and photoreceptors may be involved secondarily.