EOG and the En-Face Inner Segment/Outer Segment-Ellipsoid Complex Image in Multiple Evanescent White Dot Syndrome.

Area of Science:

• Ophthalmology
• Medical Imaging
• Retinal Diseases

Background:

• Multiple Evanescent White Dot Syndrome (MEWDS) is an idiopathic inflammatory condition affecting the outer retina.
• Typical diagnostic methods include fundus photography, autofluorescence, and OCT, but atypical findings necessitate advanced imaging.
• Electrooculogram (EOG) assesses retinal pigment epithelium and photoreceptor function, with Arden ratio being a key metric.

Observation:

• A 25-year-old female presented with acute, painless visual impairment and photopsia in the right eye.
• Multimodal imaging revealed multifocal white spots, foveal granularity, and hyperautofluorescence in the affected eye.
• Spectral-domain Optical Coherence Tomography (SD-OCT) showed disruption of the ellipsoid zone and photoreceptor outer segments.

Findings:

• En-face imaging, specifically minimum intensity projection (Min-IP) and inner segment/outer segment-ellipsoid complex, revealed hyperreflective spots in the affected eye.
• Interestingly, similar hyperreflective spots were noted in the fellow eye on en-face imaging of the inner segment/outer segment-ellipsoid complex.
• Atypical EOG findings were observed, with an Arden ratio of 2.5 in the right eye and 1.7 in the left eye.

Implications:

• En-face imaging of the inner segment/outer segment-ellipsoid complex demonstrates aberrant features in MEWDS, potentially extending to the fellow eye.
• The observed abnormalities in en-face imaging and EOG warrant further investigation into the pathogenesis of MEWDS.
• These advanced imaging techniques may provide novel insights into the pathophysiology and diagnostic criteria for MEWDS.