Relationship between different fluorescein and indocyanine green angiography features in multiple evanescent white dot syndrome

Abstract

Angiographic features may vary in eyes with similar clinical signs of MEWDS. Such variability could reflect the different anatomical structures involved during the natural evolution of the disease. Angiographic studies suggest that both, inner and outer choroid, are involved in this disorder. The final outcome is not affected by the initial angiographic presentation.

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

“…The angiographic characteristics, either from FA or indocyanine green angiography, can vary in patients with similar visual complaints. According to previous studies, the reason for this is that there are many other ocular structures involved in the physiopathology of this disease (5) . Moreover, it is important to highlight that, in apparently normal fundoscopy patients with scotomas and photopsias, dots and spots at the near peripheral retina can be found via FA, suggesting MEWDS.…”

“…There may be fluorescein leakage from the optic nerve, and occasionally, there may be late staining of the retinal blood vessels due to a mild vasculitis. Incidentally, final recovery is not related to the initial angiographic lesions (5) . Considering its good prognosis, we aimed to study the epidemiology of MEWDS to confirm the usefulness of FA as a complementary tool that is accessible at most ophthalmic clinics, which could allow MEWDS-like lesions to be identified more easily, thus ensuring good prognosis, and avoiding unnecessary treatment.…”

Multiple Evanescent White Dot Syndrome (MEWDS)

“…[19][20][21][22][23] A hypocyanescent annular area surrounding the optic disc is often visible and correlate with the enlarged blind spot on visual field (Fig. 1).…”

“…17 However, other studies did report early hypofluorescence or concomitant presence of hyperfluorescence and hypofluorescence in correspondence to the dots in the acute phase. 18,19 These differences are probably related to the severity of inflammation, variable interval between onset of symptoms and examination, and different equipment and modality used to record images.…”

“…20 Conversely, the early hypofluorescence could be due to impaired perfusion of the inner choroid or to a masking effect of the inflammatory lesions on the choroidal fluorescence. 19 During the course of the disease, the angiographic findings may change (ie, areas of early hypofluorescence may turn into areas of early hyperfluorescence) or persist, respectively, indicating sequential resolution or persistency of damage at the level of different retinal and choroidal layers. 19 ' Indocyanine Green Angiography (ICGA) Findings and Role of ICGA in Diagnosis and Management…”