MULTIPLE EVANESCENT WHITE DOT SYNDROME WITH CENTRAL VISUAL LOSS.

Area of Science:

• Ophthalmology
• Retinal Diseases
• Inflammatory Eye Conditions

Background:

• Multiple evanescent white dot syndrome (MEWDS) is an inflammatory condition typically affecting young myopic women.
• MEWDS is characterized by transient visual disturbances and characteristic fundus findings, usually resolving without sequelae.

Observation:

• A 64-year-old male presented with unilateral decreased vision and central scotoma, exhibiting features of MEWDS.
• Ophthalmic examination revealed MEWDS alongside significant macular pigmentary atrophy and outer retinal disorganization, suggesting superimposed structural disease.
• Imaging studies indicated MEWDS lesions, central hypofluorescence, retinal pigment epithelial detachment, and pachychoroid features.

Findings:

• The MEWDS lesions resolved, but central vision remained impaired due to persistent structural macular damage.
• Treatment with systemic steroids and anti-VEGF therapy did not improve the central visual deficit.
• The case did not evolve into other inflammatory retinal phenotypes like multifocal choroiditis or acute zonal occult outer retinopathy (AZOOR).

Implications:

• This case highlights an atypical MEWDS presentation with severe, persistent central vision loss due to underlying structural macular disease.
• The findings suggest a possible superimposed pachychoroid spectrum condition unrelated to the inflammatory MEWDS phenotype.
• Understanding such presentations is crucial for accurate diagnosis and management of complex retinal disorders.