Multiple evanescent white dot syndrome and multiple evanescent white dot syndrome-like change / 中华眼底病杂志

Multiple evanescent white dot syndrome (MEWDS) is an acute retinal disease characterized by multifocal white spots in the fundus often seen in the unilateral eye. The lesions mainly involve the retinal pigment epithelium and the outer retinal structure. Typical ocular manifestations of MEWDS include grayish-white outer retinal spots with a clear borderline identified on the fundus, findings of hyper-autofluorescence in the early stage consistent with the spots identified on the fundus, and the optical coherence tomography manifestation of multifocal disruption of the ellipsoid zone. With the rapid development of multimodal imaging technology, some scholars found that these manifestations are not exclusive to MEWDS as some types of chorioretinopathy can also show MEWDS-like changes. The etiology of these diseases may be inflammation, infection, immunity, or tumor-related, misdiagnosed by masquerading as MEWDS. Here we summarized the clinical manifestations and imaging features of MEWDS and reviewed the fundus lesions changes that can be misdiagnosed as MEWDS.

A Case of Punctate Inner Choroidopathy Followed by Multiple Evanescent White Dot Syndrome

PURPOSE: To report a delayed onset of multiple evanescent white dot syndrome in a patient with punctate inner choroidopathy. CASE SUMMARY: A 23-year-old female complained about sudden visual loss in the right eye. Best-corrected visual acuity (BCVA) was 20/100 in the right eye and 20/20 in the left eye. In fundus examination and optical coherence tomographic images, subfoveal choroidal neovascularization (CNV) with hemorrhage was observed in the right eye, accompanied by multiple lesions of atrophic pigmentation on the posterior pole in both eyes. We diagnosed the patient as punctate inner choroidopathy (PIC) and CNV in the right eye, and treated her using three monthly intravitreal injections of bevacizumab (Avastin®, Roche, Basel, Switzerland; 1.25 mg/0.05 mL). The CNV regressed and the BCVA improved to 20/20. Two years later, she complained of visual impairment in her left eye. The BCVA was 20/40. Fundus photography revealed numerous small white dots around the posterior pole and optic disc. Disruption of the photoreceptor layer was seen in optical coherence tomography images. Small white dots were observed as multiple hyperfluorescent dots in fluorescein angiography and hypofluorescent spots in indocyanine green angiography. An enlarged blind spot was observed in the visual field. We diagnosed her as multiple evanescent white dot syndrome (MEWDS). One month after systemic steroid treatment, the multiple white dots disappeared and the BCVA improved to 20/20. CONCLUSIONS: We determined that PIC and MEWDS, which belong to the white dot syndrome, could occur in a patient at different times.

Multiple Evanescent White-Dot Syndrome in a 14-Year-Old Girl

PURPOSE: To report a case of multiple evanescent white-dot syndrome (MEWDS) in a 14-year-old female. CASE SUMMARY: A 14-year-old female presented with decreased visual acuity. Review of systems was unremarkable except for a recent upper respiratory infection prior to her symptoms. On examination, her visual acuity was 20/20 in the right eye and 20/200 in the left eye. Relative afferent pupillary defect was observed. Examination of the left fundus revealed optic disc edema and multiple white dots in the posterior pole. Humphrey visual field test showed enlargement of the blind spot in the left eye. Fluorescein angiography revealed hyperfluorescence and late leakage of the white dots. Indocyanine green angiography showed enlarged late hypofluorescence of the white dots. MEWDS was diagnosed and the patient was followed up with serial examinations. At a follow-up examination 2 weeks later, visual acuity in the left eye improved to 20/70. The majority of white dots on fundus had disappeared and the enlarged scotoma in the left eye recovered to normal size on Humphrey visual field test. At a follow-up examination 3 months later, visual acuity in the left eye improved to 20/30 and residual white dots had further disappeared. CONCLUSIONS: Cases of MEWDS have been reported in patients as old as 67 years; however, MEWDS is a rare disease and most patients are young females. The authors describe the youngest case to date in Korea of MEWDS in 14-year-old female with typical clinical course.

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.

Multifocal Electrophysiologic Findings in MEWDS: Multiple Evanescent White Dot Syndrome

PURPOSE: To evaluate the relationship between the lesions of the MEWDS, retinal dysfunction and the cause of decreased visual acuity. METHODS: A patient with a medical history, retinal finding, and the fluorescein angiographic findings consistent with the diagnosis of MEWDS is described. Full field ERG and mfERG were performed and the results was analyzed to find the relationship the visual acuity and the fluorescein angiographic findings. RESULTS: mfERG of the involved eye shows diffuse depression of the amplitude accentuated by focal areas of steep depression thought to correspond to white spot and full field ERG shows generalized depressed signal. The mfERG abnormalities seen at the presentation resolved with the resolution of visual symptoms after 1 month. CONCLUSIONS: The major symptoms of the patient is due to the decreased retinal function and the mfERG is seem to be the useful and safe tool for evaluation of the retinal function and the relationship between the symptoms and the white dots.

Multiple Evanescent White Dot Syndrome with Ebstein-Barr Virus Infection

Multiple Evanescent White Dot Syndrome is a clinical disorder of unknown etiology that affects primarily the retinal pigment epithelium and photoreceptors, usually manifests with acute visual loss or blurred vision. The course of MEWDS is recoverable over several weeks. Characteristic ocular manifestations may include multiple white dots in the deep retina of posterior pole, granularity of the macula, optic disc edema, and vitreous cells. Fluorescein angiography shows small punctate areas of hyper-fluorescence at the level of the retinal pigment epithelium corresponding to the white dots and late fluorescein staining, fluorescein leakage from disc capillaries. We experienced a case of suspected Multiple Evanescent White Dot Syndrome with Ebstein-Barr virus infection and reviewed the available literatures regarding the disease entity.

Two cases of Multiple Evanescent White Dot Syndrome

Multiple evanscent white dot syndrom(MEWDS) has the characteristic clinical, funduscopic, fluorescein angiographic and electrophysiologic findings. The etiology of MEWDS remains unknown. The authors report on two patients with MEWDS. They were young females. Funduscopic examination showed that multiple, white dots are found at the level of the retinal pigment epithelium. These dots extended from macula into mideriphery. Also, the patients had a tiny, granular gray-white dots in the fovea. Fluorescein angiography showed an early hyperfluorescence in the areas corresponding to the white dots with late staining. Two patients had spontaneous recovery of vision in four to seven weeks. They had persistent enlargement of the physiologic blind spot or paracentral scotoma in their visual field, respectively.

Multiple Evanescent White Dot Syndrome

Multipe Evanescent White Dot Syndrome is a clinical disorder of unknown etiology usually resulting in acute visual loss It affects primarily the retinal pigment epithelium and photoreceptors, Ocular manifestations may include multiple white dots at the level of the retinal pigment epithelium, granulaity of the macula, optic nerve swelling and anterior chamber and vitreous cells. Fluorescein angiogram discloses hyperfluorescence in association with the white spots and late staining and dye leakage from disc capillaries. We experienced a case of Multiple Evanescent White Dot Syndrome and reviewed the available literatures regarding this disease.