Fundus autofluorescence in multiple evanescent white dot syndrome

Area of Science:

• Ophthalmology
• Retinal Diseases
• Choroidal Imaging

Background:

• Multiple Evanescent White Dot Syndrome (MEWDS) is an idiopathic inflammatory condition affecting the outer retina and choroid.
• Understanding the precise sequence of ocular layer involvement in MEWDS is crucial for diagnosis and management.

Observation:

• A patient presented with acute photopsia and vision loss in the left eye.
• Funduscopy revealed foveal granularity and posterior pole lesions. Autofluorescence imaging showed hyperautofluorescence, while fluorescein angiography demonstrated early hyperfluorescent dots with late staining.
• Indocyanine green angiography revealed a higher number of hypofluorescent lesions compared to other imaging modalities.

Findings:

• The patient's visual acuity improved to 20/20 within 30 days with near-normal complementary exams.
• Indocyanine green angiography indicated persistent, though reduced, hypofluorescent lesions.
• The findings support the hypothesis of primary choroidal inflammation in MEWDS, followed by secondary retinal pigment epithelium and neurosensory retina involvement.

Implications:

• This case highlights the utility of Indocyanine green angiography in diagnosing MEWDS by revealing deeper choroidal pathology.
• The study reinforces the understanding of MEWDS pathophysiology, emphasizing initial choroidal changes.
• Accurate diagnosis and understanding of MEWDS progression can guide treatment strategies and patient counseling.