Atlas of Ophthalmology


Retina -> Aquired Macular Diseases
Patient: 32 years of age, female, BCVA 0.5 at OD, 1.0 at OS, IOP 15/16 mmHg. Ocular Medical History: decreased vision in the right eye for 1 week, associated with a peripheral scotoma with shimmering effect of the vision. General Medical History: no events reported. Purpose: to present unilateral white dot syndrome with central macular dysfunction. Methods: Colour Photography Posterior Pole, Optical Coherence Tomography SD-OCT, Autofluorescence Imaging AF, Fluorescein angiography FFA. Findings: Colour Photography Posterior Pole: multiple white spots extending from the posterior pole out to the mid-peripheral retina. Autofluorescence: prominent macula hypofluorescence, hyperfluorescence and reflectance changes of MEWDS in a zone of posterior pole. SD-OCT: macular disorganization of the outer retina with focally disrupted photoreceptor inner/outer segment (IS/OS) junction line, mild disruptions of outer retina in the regions of the MEWDS lesions,. FFA: hyperfluorescence at the white spots indicating hypoperfusion of the choriocapillaris in the regions of the MEWDS lesions. Visual Field: central and peripheral visual field defects. Mosaic, Colour Photography Posterior Pole, Autofluorescence, FFA: Colour Photography presenting multiple white spots, Autofluorescence revealing prominent macula hypofluorescence, hyperfluorescence of MEWDS, FFA showing hyperfluorescence at the white spots indicating hypoperfusion of the choriocapillaris in the regions of the MEWDS lesions. Discussion: Multiple evanescent white dot syndrome (MEWDS ) has been considered an inflammatory disease of the RPE or deep retina . MEWDS is an acute, usually unilateral chorioretinopathy with varying degrees of retinal and choroidal involvement and with multiple yellow or white spots in the fundus. Patients report blurred vision, photopsia, or visual field defects. The cause is unknown. Hyperfluorescence in fluorescein angiography was interpreted to be hypoperfusion of the choriocapillaris. Li et al. (1) followed seven patients with unilateral MEWDS. He found during 1.5 weeks to 6 months follow-up, the BCVA returned to 1.0 along with resolution of the white dots in all patients. Literature: (1) Li D, Kishi S. Restored photoreceptor outer segment damage in multiple evanescent white dot syndrome. Ophthalmology. 2009 Apr;116(4):762-70

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