MULTIPLE EVANESCENT WHITE DOT SYNDROME WITH SUBRETINAL DEPOSITS.

PURPOSE To describe the multimodal imaging findings of transient subretinal deposits occurring in multiple evanescent white dot syndrome (MEWDS). METHODS The multimodal imaging characteristics of transient subretinal deposits occurring in MEWDS were investigated with ultra-widefield color and fundus autofluorescence, cross-sectional and en-face optical coherence tomography (OCT), en face OCT-angiography, and quantitative autofluorescence. RESULTS A 28-year-old woman presented with photopsia and temporal visual field loss in her right eye. Her best-corrected visual acuity was 20/20 in her right eye and 20/25 in her left eye. Funduscopic examination showed characteristic peripapillary hyperautofluorescent white dots of MEWDS corresponding to ellipsoid zone disruption on OCT. These lesions became confluent throughout the posterior fundus over the next 4 weeks. As the patient's symptoms were resolving, a second type of transient hyperautofluorescent lesion was noted which corresponded to hyperreflective subretinal deposits on cross-sectional and en face structural OCT. These subretinal deposits were most evident at 10-week follow-up and had nearly resolved at 14-week follow-up. Quantitative autofluorescence showed that, unlike the acute MEWDS lesions, the hyperautoflurescence of the subretinal deposits persisted after photobleaching. At multiple time points over 14 weeks of follow-up, OCT angiography showed no evidence of retinal or choroidal flow abnormalities. CONCLUSION Transient subretinal deposits may develop during MEWDS in areas of previous diffuse outer retinal disruption. As these deposits remain hyperautoflurescent on quantitative autofluorescence after photobleaching, they may represent accumulations of debris originating from damaged photoreceptor outer segments.

[1]  K. Freund,et al.  EN FACE OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF MULTIPLE EVANESCENT WHITE DOT SYNDROME: New Insights Into Pathogenesis. , 2016, Retina.

[2]  G. Staurenghi,et al.  Interpretation of fundus autofluorescence changes in choriocapillaritis: a multi-modality imaging study , 2016, Graefe's Archive for Clinical and Experimental Ophthalmology.

[3]  Peter Charbel Issa,et al.  Quantitative Fundus Autofluorescence in Early and Intermediate Age-Related Macular Degeneration. , 2016, JAMA ophthalmology.

[4]  B. Lujan,et al.  EXPANDED CLINICAL SPECTRUM OF MULTIPLE EVANESCENT WHITE DOT SYNDROME WITH MULTIMODAL IMAGING , 2016, Retina.

[5]  S. Kishi,et al.  Ultra-wide-field fundus autofluorescence in multiple evanescent white dot syndrome. , 2015, American journal of ophthalmology.

[6]  I. Kimura,et al.  Photoreceptor inner and outer segment layer thickness in multiple evanescent white dot syndrome , 2014, Graefe's Archive for Clinical and Experimental Ophthalmology.

[7]  Richard F Spaide,et al.  Pseudodrusen subtypes as delineated by multimodal imaging of the fundus. , 2014, American journal of ophthalmology.

[8]  Ken Ogino,et al.  Cone abnormalities in fundus albipunctatus associated with RDH5 mutations assessed using adaptive optics scanning laser ophthalmoscopy. , 2014, American journal of ophthalmology.

[9]  Jesse J. Jung,et al.  Increased fundus autofluorescence related to outer retinal disruption. , 2013, JAMA ophthalmology.

[10]  J. Sorenson,et al.  Fundus autofluorescence and photoreceptor bleaching in multiple evanescent white dot syndrome. , 2013, Ophthalmic surgery, lasers & imaging retina.

[11]  T. Aleman,et al.  Retinal structure in vitamin A deficiency as explored with multimodal imaging , 2013, Documenta Ophthalmologica.

[12]  R. T. Smith,et al.  Quantitative measurements of autofluorescence with the scanning laser ophthalmoscope. , 2011, Investigative ophthalmology & visual science.

[13]  K. Freund,et al.  MULTIMODAL FUNDUS IMAGING OF PSEUDOXANTHOMA ELASTICUM , 2011, Retina.

[14]  A. Mantovani,et al.  NATURAL EVOLUTION OF FUNDUS AUTOFLUORESCENCE FINDINGS IN MULTIPLE EVANESCENT WHITE DOT SYNDROME: A Long-Term Follow-Up , 2010, Retina.

[15]  Danjie Li,et al.  Restored photoreceptor outer segment damage in multiple evanescent white dot syndrome. , 2009, Ophthalmology.

[16]  P. Sieving,et al.  Multiple evanescent white dot syndrome. I. Clinical findings. , 1984, Archives of ophthalmology.

[17]  A. Gaudric,et al.  WHY THE DOTS ARE BLACK ONLY IN THE LATE PHASE OF THE INDOCYANINE GREEN ANGIOGRAPHY IN MULTIPLE EVANESCENT WHITE DOT SYNDROME , 2017, Retinal cases & brief reports.

[18]  D. Sarraf,et al.  EN FACE OPTICAL COHERENCE TOMOGRAPHY OF MULTIPLE EVANESCENT WHITE DOT SYNDROME , 2017, Retinal cases & brief reports.

[19]  M. Slusher,et al.  Multiple evanescent white dot syndrome. , 1988, Retina.