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MJ Landolfi, R Grigorian, R Folberg, P Langer, N Mirani, N Bhagat, M Zarbin; Presumed Sympathetic Ophthalmia Mimicking MEWDS . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4493.
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Purpose: To report a case of sympathetic ophthalmia (SO) resembling multiple evanescent white dot syndrome(MEWDS) Methods: Retrospective chart review. Results: A 17-year old woman with history of ruptured globe OD in a motor vehicle accident, underwent prompt primary repair with removal of intraocular glass foreign bodies(IOFBs), and subsequent vitrectomy, scleral buckling, silicone oil infusion with removal of additional glass IOFBs 3 weeks later. Eight weeks after injury, the patient presented with 3-day progressive vision loss OS. Vision was LP OD and 20/25 OS. Slit-lamp examination OD disclosed a clear cornea without keratatic precipitates, a well-healing corneal laceration, and an aphakic depth anterior chamber with trace cell and flare. The left eye had a clear cornea, no keratatic precipitates, a deep and quiet anterior chamber, a clear lens, and syneretic vitreous without cell. Fundus examination OD disclosed a macula-off tractional retinal detachment posterior to the scleral buckle arising from PVR. On the left, the retina was flat, and there were well-circumscribed, circular, flat, 100-500 µm-diameter areas of gray-white discoloration at the level of the RPE confined mostly posterior to the equator. The lesions spared the fovea, and there were no other retinal vascular abnormalities. Optic nervehead swelling was present. Fluorescein angiography OS showed multiple areas of blocked choroidal fluorescence in the early phases associated with leakage in a ring-like pattern, corresponding to the gray-white lesions evident on ophthalmoscopy. Dye leakage occured at the optic nervehead. B-scan ultrasound OS revealed choroidal thickening. Visual field testing showed depressed central sensitivity and an enlarged blind spot OS. The findings were thought to be consistent with inflammatory choroiditis, and SO vs. MEWDS seemed most likely. The patient was treated with prednisone 60mg po qam and underwent diagnostic enucleation OD within a week. Histopathology showed rare choroidal granulomata with pigment. Vision improved to 20/20 OS, and window defects developed in areas of previous RPE whitening. Conclusion: Based on the pathologic findings, this case reveals that SO can mimic MEWDS angiographically.
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