Multiple evanescent white dot syndrome following SARS-CoV-2 infection - A case report

To report a case of MEWDS post-COVID-19 infection with multimodal imaging. A 17-year-old boy reported blurring of vision in both eyes 2 months and 10 days following the SARS-CoV-2 infection. Fundus examination revealed hypopigmented lesions nasal to the optic disc, inferior periphery, and near macula in both eyes. Multimodal imaging was consistent with MEWDS. A complete systemic workup was performed to exclude infectious etiology. Fundus lesions resolved with a course of oral corticosteroids and was confirmed on multimodal imaging.

FAG, ICG and OCT Findings in Multiple Evanescent White Dot Syndrome

PURPOSE: We evaluated one patient with multiple evanescent white dot syndrome (MEWDS), using fundus fluorescein angiography (FAG), indocyanine green angiography (ICGA), optical coherence tomography (OCT) on acute phase of the disease, at 2 weeks after onset and at 10weeks. METHODS: Each diagnostic images were compared with patient's clinical course .OCT measurements of serial retinal thickness were done to assess the change in retinal thickness over the disease process. RESULTS: White dots on fundoscopic examination showed hypofluorescent on ICGA and imaged hyperreflective on OCT without presence of neither subretinal fluid nor neuroretinal increase in thickness. These ICGA and OCT findings suggest that lesions of perfusion defect on ICGA may be caused by interstitial precipitations of inflammatory cells in choriocapillaries and the underlying mechanism is not due to vasculitis with edema or serous exudation. CONCLUSIONS: ICGA and OCT allowed more precise anatomic evaluation than FAG in diagnosis and correlated well with clinical symptoms.

A Case of Subfoveal Choroidal Neovascularization following Multiple Evanescent White-Dot Syndrome

PURPOSE: We report a case of subfoveal choroidal neovascularization following multiple evanescent white dot syndrome (MEWDS). METHODS: A 28-year-old female patient with vitreous floater and scotoma of her right eye was diagnosed with MEWDS. Fundus examination revealed multiple white dots at midperipheral retina, and a granular appearance of macular, which were nearly subsided at 1 month after her first visit. She complained of a sudden decrease in visual acuity of right eye at 3 months after her initial episode of MEWDS. Fundus examination showed macular hemorrhage with edema. Typical subfoveal choroidal neovascularization with leakage was confirmed by Indocyanine Green Angiography (ICGA), which was treated by photodynamic therapy (PDT). RESULTS: Subfoveal choroidal neovascularization following MEWDS is rare, and this is the first Korean case report.

Indocyanine Green Angiographic Findings in Multiple Evanescent White Dot Syndrome

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.