The multimodal imaging characteristics of multiple evanescent white dot syndrom_Chinese Journal of Ocular Fundus Diseases

Authors：

Lu Yan ^1,2 , Zheng Penxiang ² , Ye Zuke ² , Yin Xiaofang ² ,  He Mingguang ¹

1. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China;
2. Eye Center, The Second People’s Hospital of Foshan, Foshan 528000, China;

Corresponding author：

He Mingguang, Email: mingguanghe@gmail.com

Keywords：

Retinal diseases/diagnosis; Multimodal imaging characteristics

DOI：

10.3760/cma.j.issn.1005-1015.2019.04.004

Video：

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Objective To observe the multimodal imaging characteristics of multiple evanescent white dot syndrom (MEWDS).Methods This was a retrospective series case study. Eighteen patients (18 eyes) diagnosed with MEWDS in Eye Center of The Second People’s Hospital of Foshan from September 2015 to April 2017 were enrolled in this study. There were 12 females and 6 males, with the mean age of 35.9 years. The disease course ranged from 3 to 90 days, with the mean of 14 days. All the patients underwent BCVA, slit-lamp microscope with +90D preset lens, fundus photography, spectral domain OCT (SD-OCT) and FAF examinations. FFA was simultaneously performed in 6 eyes, FFA and ICGA were simultaneously performed in 12 eyes. Ten patients received the treatment of glucocorticoids and vasodilator substance, and other 8 patients without any treatment. The follow-up duration was 4.5 months. The multimodal imaging characteristics were reviewed and analyzed.Results Fundus color photography showed a variable number of small dots and large spots lesions (14 eyes), and/or fovea granularity (7 eyes) and disk swelling (5 eyes). A variable number of little dots and larger spots lesions showed respectively in FFA, FAF and ICGA were needle-like dots distributed in a wreathlike pattern and a large plaque occasionally confluent of early highly fluorescent, highly autofluorescence and hypofluoresence. Combined hypofluorescent spots with overlying dots were observed in 10 eyes of the late stages of the ICGA. Black lesions in the gray background show in ICGA were the most obvious and the most extensive, gray-white lesions in the gray-black show in FAF were the second, light gray-black lesions in the gray show in FFA were the least. Gray-white lesions in an orange background show in fundus photography were not obvious and transient. SD-OCT showed disruption of the ellipsoid zone and/or accumulations of hyperreflective material from the ellipsoid layer toward the outer plexiform layer and vitreous cells. During the period of following-up, some patients were prescribed low-dose glucocorticoid and some not, almost all the patients except one patient experienced recovery in BCVA and the lesions in fundus imaging.Conclusions The lesions in MEWDS eyes in modern multimodal imaging modalities among fundus photography (fovea granularity), FFA (needle-like dots distributed in a wreathlike pattern and a large plaque occasionally confluent of early highly fluorescent), ICGA (flake hypofluorescent) and SD-OCT (disruption of the ellipsoid zone) showed good consistency. Almost eyes were recovery.

Citation： Lu Yan, Zheng Penxiang, Ye Zuke, Yin Xiaofang, He Mingguang. The multimodal imaging characteristics of multiple evanescent white dot syndrom. Chinese Journal of Ocular Fundus Diseases, 2019, 35(4): 333-337. doi: 10.3760/cma.j.issn.1005-1015.2019.04.004 Copy

1.	Jampol LM, Sieving PA, Pugh D, et al. Multiple evanescent white dot syndrome. Ⅰ. Clinical findings[J]. Arch Ophthalmol, 1984, 102(5): 671-674. DOI: 10.1001/archopht.1984.01040030527008.
2.	Marsiglia M, Gallego-Pinazo R, Cunha de Souza E, et a1. Expanded clinical spectrum of multiple evanescent white dot syndrome with multimodal imaging[J]. Retina, 2016, 36(1): 64-74. DOI: 10.1097/IAE.0000000000000685.
3.	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(9): 1089-1098. DOI: 10.1001/jamaophthalmol.2014.1683.
4.	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.
5.	陈如, 俞素勤, 邹文军, 等. 多发性一过性白点综合征患眼超广角短波长眼底自身荧光特征[J]. 中华眼底病杂志, 2016, 32(3): 252-256. DOI: 10.3760/cma.j.issn.1005-1015.2016.03.006.Chen R, Yu SQ, Zou WJ, et al. Imaging features of ultra-wide field fundus autofluorescence in multiple evanescent white dot syndrome[J]. Chin J Ocul Fundus Dis, 2016, 32(3): 252-256. DOI: 10.3760/cma.j.issn.1005-1015.2016.03.006.
6.	刘洪涛, 张军军, 曾志冰, 等. 多发性一过性白点综合征多种眼底影像特征分析[J]. 中华眼底病杂志, 2016, 32(3): 257-260. DOI: 10.3760/cma.j.issn.1005-1015.2016.03.007.Liu HT, Zhang JJ, Zeng ZB, et al. Characteristics of multiple evanescent white dot syndrome with multimodal imaging[J]. Chin J Ocul Fundus Dis, 2016, 32(3): 257-260. DOI: 10.3760/cma.j.issn.1005-1015.2016.03.007.
7.	Patrinoiu G, Calderón-Moreno JM, Chifiriuc CM, et al. Tunable ZnO spheres with high anti-biofilm and antibacterial activity via a simple green hydrothermal route[J]. J Colloid Interface Sci, 2016, 462: 64-74. DOI: 10.1016/j.jcis.2015.09.059.
8.	Shelsta HN, Rao RR, Bhatt HK, et al. Atypical presentations of multiple evanescent white dot syndrome without white dots: a case series[J]. Retina, 2011, 31(5): 973-976. DOI: 10.1097/IAE.0b013e31820a67cc.
9.	周才喜, 苑志峰, 刘立民, 等. 多发性一过性白点综合征的频域光相干断层扫描检查特征[J]. 中华眼底病杂志, 2012, 28(4): 397-399. DOI: 10.3760/cma.j.issn.1005-1015.2012.04.020.Zhou CX, Yuan ZF, Liu LM, et al. The imaging features of the multiple evanescent white dot syndrome demonstrated by ultrahigh resolution optical coherence tomography[J]. Chin J Ocul Fundus Dis, 2012, 28(4): 397-399. DOI: 10.3760/cma.j.issn.1005-1015.2012.04.020.
10.	Nguyen MH, Witkin AJ, Reichel E, et al. Microstructural abnormalities in MEWDS demonstrated by ultrahigh resolution optical coherence tomography[J]. Retina, 2007, 27(4): 414-418. DOI: 10.1097/01.iae.0000246676.88033.25.
11.	Ikeda N, Ikeda T, Nagata M, et al. Location of lesions in multiple evanescent white dot syndrome and the cause of the hypofluorescent spots observed by indocyanine green angiography[J]. Graefe's Arch Clin Exp Ophthalmol, 2001, 239(3): 242-247. DOI: 10.1007/s004170100276.

1. Jampol LM, Sieving PA, Pugh D, et al. Multiple evanescent white dot syndrome. Ⅰ. Clinical findings[J]. Arch Ophthalmol, 1984, 102(5): 671-674. DOI: 10.1001/archopht.1984.01040030527008.
2. Marsiglia M, Gallego-Pinazo R, Cunha de Souza E, et a1. Expanded clinical spectrum of multiple evanescent white dot syndrome with multimodal imaging[J]. Retina, 2016, 36(1): 64-74. DOI: 10.1097/IAE.0000000000000685.
3. 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(9): 1089-1098. DOI: 10.1001/jamaophthalmol.2014.1683.
4. 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.
5. 陈如, 俞素勤, 邹文军, 等. 多发性一过性白点综合征患眼超广角短波长眼底自身荧光特征[J]. 中华眼底病杂志, 2016, 32(3): 252-256. DOI: 10.3760/cma.j.issn.1005-1015.2016.03.006.Chen R, Yu SQ, Zou WJ, et al. Imaging features of ultra-wide field fundus autofluorescence in multiple evanescent white dot syndrome[J]. Chin J Ocul Fundus Dis, 2016, 32(3): 252-256. DOI: 10.3760/cma.j.issn.1005-1015.2016.03.006.
6. 刘洪涛, 张军军, 曾志冰, 等. 多发性一过性白点综合征多种眼底影像特征分析[J]. 中华眼底病杂志, 2016, 32(3): 257-260. DOI: 10.3760/cma.j.issn.1005-1015.2016.03.007.Liu HT, Zhang JJ, Zeng ZB, et al. Characteristics of multiple evanescent white dot syndrome with multimodal imaging[J]. Chin J Ocul Fundus Dis, 2016, 32(3): 257-260. DOI: 10.3760/cma.j.issn.1005-1015.2016.03.007.
7. Patrinoiu G, Calderón-Moreno JM, Chifiriuc CM, et al. Tunable ZnO spheres with high anti-biofilm and antibacterial activity via a simple green hydrothermal route[J]. J Colloid Interface Sci, 2016, 462: 64-74. DOI: 10.1016/j.jcis.2015.09.059.
8. Shelsta HN, Rao RR, Bhatt HK, et al. Atypical presentations of multiple evanescent white dot syndrome without white dots: a case series[J]. Retina, 2011, 31(5): 973-976. DOI: 10.1097/IAE.0b013e31820a67cc.
9. 周才喜, 苑志峰, 刘立民, 等. 多发性一过性白点综合征的频域光相干断层扫描检查特征[J]. 中华眼底病杂志, 2012, 28(4): 397-399. DOI: 10.3760/cma.j.issn.1005-1015.2012.04.020.Zhou CX, Yuan ZF, Liu LM, et al. The imaging features of the multiple evanescent white dot syndrome demonstrated by ultrahigh resolution optical coherence tomography[J]. Chin J Ocul Fundus Dis, 2012, 28(4): 397-399. DOI: 10.3760/cma.j.issn.1005-1015.2012.04.020.
10. Nguyen MH, Witkin AJ, Reichel E, et al. Microstructural abnormalities in MEWDS demonstrated by ultrahigh resolution optical coherence tomography[J]. Retina, 2007, 27(4): 414-418. DOI: 10.1097/01.iae.0000246676.88033.25.
11. Ikeda N, Ikeda T, Nagata M, et al. Location of lesions in multiple evanescent white dot syndrome and the cause of the hypofluorescent spots observed by indocyanine green angiography[J]. Graefe's Arch Clin Exp Ophthalmol, 2001, 239(3): 242-247. DOI: 10.1007/s004170100276.

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