Characteristics of multiple evanescent white dot syndrome with multimodal imaging_Chinese Journal of Ocular Fundus Diseases

Authors：

LiuHongtao ,  ZhangJunjun , ZengZhibing , BaoLi

Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

ZhangJunjun, Email: zhangjunjun@medmail.com.cn

Keywords：

Retinal diseases/diagnosis; Fluorescein angiography; Indocyanine green; Tomography, optical coherence; Diagnostic imaging

DOI：

10.3760/cma.j.issn.1005-1015.2016.03.007

Video：

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Objective To observe the characteristics of multiple evanescent white dot syndrome (MEWDS) with modern multimodal imaging modalities. Methods This was a retrospective case study. Eleven patients (11 eyes) diagnosed with MEWDS were enrolled. There were 10 females and 1 male, mean age was 27.6 years (range 15-41 years). The period between disease onset and visiting to the hospital was between 2 to 13 days, the average time was 4.7 days. All the patients underwent examinations of best corrected visual acuity, slit-lamp biomicroscope, indirect ophthalmoscope, fundus color photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA) and spectral domain optical coherence tomography (SD-OCT). The mean follow up duration was 3.2 months. The imaging characteristics were compared. Results Fundus color photography showed foveal orange-red granularity in all eyes. FAF showed strong autofluorescence with a vague boundary. FFA showed a variable number of highly fluorescent fine needle-like dots arranged in a ring in the early stage, and fluorescence remained in the late stage. ICGA showed advanced lesions of vague boundary merged into a large plaque of deep retinal hypofluorescence. SD-OCT showed the hyperreflectant material deposit over the retinal pigment epithelium and extending anteriorly through the interdigitation zone, ellipsoid layer, and toward the external limiting membrane. At the site of extrafoveal lesions, SD-OCT revealed the presence of discontinuities or disruptions centered on the ellipsoid zone to include the interdigitation. Conclusions In MEWDS patients, fundus photography showed foveal orange-red granularity; FFA showed early fluorescent dots distributed in a ring pattern; ICGA showed hypofluorescent lesions in the later stage; SD-OCT showed disruption of the interdigitation zone and ellipsoid zone and accumulations of hyperreflective material that was of variable size and shape; FAF showed strong autofluoresce areas that correlated to spots observed with FFA and ICGA.

Citation： LiuHongtao, ZhangJunjun, ZengZhibing, BaoLi. Characteristics of multiple evanescent white dot syndrome with multimodal imaging. Chinese Journal of Ocular Fundus Diseases, 2016, 32(3): 257-260. doi: 10.3760/cma.j.issn.1005-1015.2016.03.007 Copy

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2.	周才喜, 刘立民, 毛爱玲, 等.多发性一过性白点综合征的眼底自发荧光观察[J].中华眼科杂志, 2013, 49(12):1089-1093.DOI:10.3760/cma.j.issn.04124081.2013.12.007. .ZhouCX, LiuLM, MaoAL, etal.Thefundusautofluorescenceofthemultipleevanescentwhitedotsyndrome[J].ChinJOphthalmol, 2013, 49(12):1089-1093.DOI:10.3760/cma.j.issn.04124081.2013.12.007.
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4.	Shelsta H, Rao RR, Bhatt HK, et al. Atypical presentationsof multiple evanescent white dot syndrome (MEWDS) without white dots:a case series[J].Retina, 2011, 31(5):973-976. DOI:10.1097/IAE.0b013e31820a67cc.
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8.	Mrejen S, Khan S, Gallego-Pinazo R, et al. Acute zonal occult outer retinopathy:a classification based on multimodal imaging[J].JAMA Ophthalmol, 2014, 132:1089-1098. DOI:10.1001/jamaophthalmol.2014.1683.
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1. Gross NE, Yannuzzi LA, Freund KB, et al. Multiple evanescent white dot syndrome[J]. Arch Ophthalmol, 2006, 124(4):493-500.
2. 周才喜, 刘立民, 毛爱玲, 等.多发性一过性白点综合征的眼底自发荧光观察[J].中华眼科杂志, 2013, 49(12):1089-1093.DOI:10.3760/cma.j.issn.04124081.2013.12.007. .ZhouCX, LiuLM, MaoAL, etal.Thefundusautofluorescenceofthemultipleevanescentwhitedotsyndrome[J].ChinJOphthalmol, 2013, 49(12):1089-1093.DOI:10.3760/cma.j.issn.04124081.2013.12.007.
3. Marsiglia M, Gallego-Pinazo R, Cunha de Souza E, et al. Expanded clinical spectrum of multiple evanescent white dot syndrome with multimodal imaging[J].Retina, 2016, 36(1):64-74.DOI:10.1097/IAE.0000000000000685.
4. Shelsta H, Rao RR, Bhatt HK, et al. Atypical presentationsof multiple evanescent white dot syndrome (MEWDS) without white dots:a case series[J].Retina, 2011, 31(5):973-976. DOI:10.1097/IAE.0b013e31820a67cc.
5. 李科军, 刘瑜玲.多发性一过性白点综合征视网膜及脉络膜造影特征分析[J].中国实用眼科杂志, 2013, 31(12):1586-1590. DOI:10.3760/cma.j.issn.1006-4443.2013.12.022.Li KJ, Liu YL.The analysis of retinal and choroidal angiography of multiple evanescent white dot syndrome[J].Chin J Pract Ophthalmol, 2013, 31(12):1586-1590. DOI:10.3760/cma.j.issn.1006-4443.2013.12.022.
6. Jampol LM, Becker KG. White spot syndromes of the retina:a hypothesis based on the common genetic hypothesis of autoimmune/inflammatory disease[J].Am J Ophthalmol, 2003, 135(3):376-379.
7. Spaide RF, Goldberg N, Freund KB. Redefining multifocal choroiditis and panuveitis and punctate inner choroidopathy through multimodal imaging[J].Retina, 2013, 33(7):1315-1324.DOI:10.1097/IAE.0b013e318286cc77.
8. Mrejen S, Khan S, Gallego-Pinazo R, et al. Acute zonal occult outer retinopathy:a classification based on multimodal imaging[J].JAMA Ophthalmol, 2014, 132:1089-1098. DOI:10.1001/jamaophthalmol.2014.1683.
9. Yzer S, Freund KB, Engelbert M.Imaging in the diagnosis and management of acute macular neuroretinopathy[J]. Int Ophthalmol Clin, 2012, 52:269-273. DOI:10.1097/IIO.0b013e31826704a4.

Chinese Journal of Ocular Fundus Diseases

Characteristics of multiple evanescent white dot syndrome with multimodal imaging

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