Atypical Presentations of Multiple Evanescent White Dot Syndrome Without White Dots

Shelsta, Heather N.; Rao, Rumya R; Bhatt, H.; Jampol, Lee M.

doi:10.1097/iae.0b013e31820a67cc

Cited by 32 publications

(20 citation statements)

References 8 publications

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“…The number of white spots is very variable, and in fact they may be absent. 32 Some investigators have suggested that MEWDS is a choroidal vascular disease. Others have considered it to be a disease of the RPE or outer retina.…”

Section: Discussionmentioning

confidence: 99%

Expanded Clinical Spectrum of Multiple Evanescent White Dot Syndrome With Multimodal Imaging

Marsiglia

Gallego-Pinazo

Souza

et al. 2016

Retina

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Purpose: To evaluate and characterize multiple evanescent white dot syndrome abnormalities with modern multimodal imaging modalities.Methods: This retrospective cohort study evaluated fundus photography, fluorescein angiography, indocyanine green angiography, optical coherence tomography, enhanced depth imaging optical coherence tomography, short-wavelength autofluorescence, and near-infrared autofluorescence.Results: Thirty-four multiple evanescent white dot syndrome patients with mean age of 28.7 years were studied (range, 14-49 years). Twenty-six patients were women, and eight were men. Initial mean visual acuity was 0.41 logMAR. Final mean visual acuity was 0.03 logMAR. Fluorescein angiography shows a variable number of mid retinal early fluorescent dots distributed in a wreathlike pattern, which correlate to fundus photography, fundus autofluorescence, and indocyanine green angiography. Indocyanine green angiography imaging shows the dots and also hypofluorescent, deeper, and larger spots, which are occasionally confluent, demonstrating a large plaque of deep retinal hypofluorescence. Optical coherence tomography imaging shows multifocal debris centered at and around the ellipsoid layer, corresponding to the location of spots seen with photography, indocyanine green angiography, and fluorescein angiography. Protrusions of the hyperreflectant material from the ellipsoid layer toward the outer nuclear layer correspond to the location of dots seen with photography, indocyanine green angiography, and fluorescein angiography.Conclusion: Multimodal imaging analysis of the retina in patients with multiple evanescent white dot syndrome shows additional features that may help in the diagnosis of the disease and in further understanding its etiology. Multiple evanescent white dot syndrome is predominantly a disease of the outer retina, centered at the ellipsoid zone, but also involving the interdigitation zone and the outer nuclear layer.RETINA 36: [64][65][66][67][68][69][70][71][72][73][74] 2016

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Section: Discussionmentioning

confidence: 99%

Expanded Clinical Spectrum of Multiple Evanescent White Dot Syndrome With Multimodal Imaging

Marsiglia

Gallego-Pinazo

Souza

et al. 2016

Retina

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“…Characteristic FA findings in MEWDS might contribute to its diagnosis, although some atypical FA aspects, such as foveal granularity without the typical white dots and associated vasculitis, were found in this study (Figures 2 and 3) (6,7) . Besides FA, other complementary exams can reveal MEWDS-like lesions, including indocyanine green angiography and autofluorescence exams showing hypocyanescent and hypo-autofluorescent lesions, respectively, which correspond to the white dots and other lesions not detected during ophthalmoscopic examination (8)(9)(10)(11) .…”

Section: Discussionmentioning

confidence: 81%

Evaluation of MEWDS-like lesions with fluorescein angiography and its frequency at an ophthalmic emergency department in Rio de Janeiro

Dias

Morizot

2015

Arquivos Brasileiros De Oftalmologia

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Avaliação de lesões com as características MEWDS ao exame de angiografia fluoresceínica e sua prevalência em serviço de emergência oftalmológica no Rio de Janeiro Results: Among the 6,111 angiographies analyzed, 15 MEWDS cases were detected; the patients ranged in age from 13 to 42 years old, and the male/female ratio was 60% to 40% (nine male and six female). The most common FA aspects included hyperfluorescent dots, dots and spots in the retinal mid-periphery, and foveal granularity in 46% of the cases. Conclusions: MEWDS has a good prognosis, with spontaneous involution, which makes it difficult to diagnose because of the delayed access to ophthalmological assistance, in special FA examination, which highlights the lesions. This study was possible due to the quick access facility at a private ophthalmic emergency department and examination by an experienced ophthalmologist, along with complementary diagnosis by FA and better perception of the patients, thus ensuring good prognosis.

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“…[4][5][6][7][8][9][10][11] Olguların yaklaşık olarak %50'sinde vitreusta hücre olabileceği ancak ön kamarada hücrenin genellikle olmadığı bilinmektedir. 3 Bu olguda ise önce ön kamara hücrelerinin hemen sonrasında da vitreus hücre-leri ve tipik retina lezyonlarının ortaya çıktığı atipik başlangıçlı bir multipl geçici beyaz nokta sendromu olgusu sunulmaktadır.…”

Section: Discussionunclassified

“…Literatürde ileri yaş başlangıçlı, bilateral, tekrarlayıcı, koroid neovasküler membran oluşu-muna neden olan, multifokal koroidit veya akut idiyopatik kör nokta genişlemesi sendromu ile birlikte ortaya çıkan ve karakteristik beyaz noktaların görülmediği atipik olgular sunulmuştur. [4][5][6][7][8][9][10] Çalışmamızda, prodromal dönemde ön üveit tanısı konulup takibinde multipl geçici beyaz nokta sendromu bulguları ortaya çıkan atipik başlangıçlı bir olgu sunulmuştur.…”

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Multiple Evanescent White Dot Syndrome with an Atypical Presentation: Case Report

Şekeroğlu¹,

Üzel²,

Anayol³

et al. 2015

Turkiye Klinikleri J Ophthalmol

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182lk kez 1984 yılında tanımlanan ve nadir görülen bir hastalık olan multipl geçici beyaz nokta sendromu, retinanın dış tabakalarında veya retina pigment epiteli seviyesindeki gri-beyaz lezyonlarla karakterize, nedeni tam olarak bilinmeyen ve genellikle tedavi edilmeksizin kendiliğinden düzelen bir hastalıktır.1,2 Hastaların çoğunda bulgular ortaya çık-madan hemen önce prodromal bir üst solunum yolu enfeksiyonu öyküsü olması, viral bir etiyolojiyi düşündürmektedir.Tipik olarak sağlıklı genç kadınlarda tek taraflı görme azalması ile ortaya çıkar. Hastalık tanısını koymaya yardımcı olan retina bulguları arka kutupta ve mid-periferde yer alan 100-200 µm büyüklüğündeki gri-beyaz lezyonlar Atipik Başlangıçlı Multipl Geçici Beyaz Nokta Sendromu Ö ÖZ ZE ET T Sağlıklı genç kadınlarda tek taraflı görme azalması ile ortaya çıkan multipl geçici beyaz nokta sendromu, tipik olarak retinanın dış tabakalarında veya retina pigment epiteli seviyesindeki gribeyaz lezyonlarla ve foveadaki granüler görünümle karakterizedir. Genellikle sistemik bir hastalık tabloya eşlik etmemektedir. Nedeni tam olarak bilinmeyen ve nadir görülen bu hastalık çoğunlukla tedavi edilmeksizin kendiliğinden düzelir. Ön segment muayenesi genellikle normal olmakla birlikte, olguların yaklaşık yarısında vitreus tutulumu görülebilir. Bu olguda, prodromal dönemde ön üveit bulguları ile ortaya çıkan atipik başlangıçlı bir multipl geçici beyaz nokta sendromu hastası-nın bir yıllık izlemi ile birlikte hastalığın tipik fundus otofloresans görüntüleme ve optik koherens tomografi bulguları sunulmuştur.A An na ah ht ta ar r K Ke el li im me el le er r: : Üveit, anterior; tomografi, optik koherens A AB BS ST TR RA AC CT T Multiple evanescent white dot syndrome is a rare disorder of young healthy female subjects presented with unilateral vision loss and can be diagnosed with foveal granularity and typical gray-white retinal lesions at the outer retina and retinal pigment epithelium. It is a self limiting disease without a need for treatment, but the exact cause is unknown. There is no defined association with systemic disorders. Vitritis can be seen in half of the cases but anterior segment examination is usually normal. Herein, we report one-year follow-up outcomes of a patient with multiple evanescent white dot syndrome who atypically presented with anterior uveitis at prodromal period and also presented its typical fundus autofluorescence and optical coherence tomography findings.

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Atypical Presentations of Multiple Evanescent White Dot Syndrome Without White Dots

Abstract: Our case series demonstrates another atypical presentation of multiple evanescent white dot syndrome that has not been described previously: foveal involvement at the onset of the disease without white spots.

Cited by 32 publications

References 8 publications

Expanded Clinical Spectrum of Multiple Evanescent White Dot Syndrome With Multimodal Imaging

Expanded Clinical Spectrum of Multiple Evanescent White Dot Syndrome With Multimodal Imaging

Evaluation of MEWDS-like lesions with fluorescein angiography and its frequency at an ophthalmic emergency department in Rio de Janeiro

Multiple Evanescent White Dot Syndrome with an Atypical Presentation: Case Report

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