Choroidal neovascularization secondary to punctate inner choroidopathy after resolution of multiple evanescent white...

White dot syndromes include multiple evanescent white dot syndrome (MEWDS) and punctate inner choroidopathy (PIC), which are rarely reported to coexist or occur sequentially in a single eye. The co-occurrence increases diagnostic complexity, and there are no previous reports of choroidal neovascularization (CNV) secondary to PIC following the resolution of MEWDS. This case report aims to supplement clinical evidence for the pathogenesis and treatment of such sequential ocular diseases.

A 42-year-old healthy female presented with blurred vision in her right eye for 3 days initially; 2 months later, her right eye vision worsened further, and 2.5 months after that, she developed blurred vision again with decreased visual acuity.

At the first visit, the patient was diagnosed with MEWDS in her right eye based on fundus examination, fundus autofluorescence, fundus fluorescein angiography, visual field test, and optical coherence tomography (OCT) findings. Two months later, she was diagnosed with PIC in the same eye due to new peripapillary yellow-white lesions and corresponding OCT changes. Another 2.5 months later, she was diagnosed with CNV secondary to PIC based on subretinal hemorrhage, abnormal vascular flow on OCT angiography, and fundus fluorescein angiography confirmation.

No treatment was given at the initial diagnosis of MEWDS. After the diagnosis of PIC, the patient received oral prednisone (1 mg/kg per day for 5 days, followed by gradual reduction over 6-8 weeks). For CNV secondary to PIC, intravitreal anti-vascular endothelial growth factor (VEGF) therapy (Ranibizumab, 0.5 mg/0.1 mL, once a month, twice in total) was administered.

After 2 intravitreal anti-VEGF injections, the best-corrected visual acuity of the patient's right eye improved to 20/20, fundic hemorrhage resolved, and OCT demonstrated complete resolution of CNV. During 2 years of follow-up, no recurrence of CNV or PIC was observed, and best-corrected visual acuity remained stable at 20/20.

MEWDS and PIC may share common etiological and pathogenetic mechanisms. PIC may develop sequentially after MEWDS in the same eye, and CNV may be a complication of PIC. A combination of oral corticosteroid therapy for PIC and timely intravitreal anti-VEGF injections for secondary CNV can achieve favorable long-term clinical outcomes. Regular follow-up is necessary for patients with MEWDS to monitor for potential progression to PIC and CNV.