Fundus Autofluorescence Findings and Ancillary Imaging in MEWDS Patients without White Dots

Abstract

 

Purpose

 

To describe multimodal imaging findings, particularly fundus autofluorescence (FAF), in patients with clinical findings suggestive of multiple evanescent white dot syndrome (MEWDS) but no white dots present on fundus examination.

 

Methods

 

We report three cases of young female patients with clinical findings suggestive of MEWDS but no white dots present on fundus examination. We performed detailed clinical examination and ancillary testing including fluorescein angiography (FA), indocynanine green angiography (ICG), spectral domain optical coherence tomography (SD-OCT), and FAF in each case.

 

Results

 

In each case, the patient's clinical presentation was consistent with MEWDS. Fundus examination demonstrated foveal granularity but no discrete white dots or hypopigmented lesions in the affected eyes. SD-OCT showed central attenuation of the photoreceptor inner segment/outer segment junction corresponding to the region of granularity in the affected eye. FAF imaging revealed multiple hyperautofluorescent spots surrounding the posterior pole. FA demonstrated hyperfluorescent dots during the late phase corresponding to the above spots on FAF. ICG demonstrated hypofluorescent dots sometimes corresponding to the same spots.

 

Conclusions

 

These cases demonstrate findings consistent with MEWDS in the absence of white dots on fundus examination. The use of additional imaging modalities, notably fundus autofluoresence, may help elucidate these white dots supporting its routine use in cases when the diagnosis is under consideration.

 

 

Color fundus photograph montage of the left eye showing foveal granularity without other discrete lesions.

 

 

Widefield fundus autofluorescence of the left eye showing multiple hyperautofluorescent spots surrounding the posterior pole.

 

Keywords: 552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • 688 retina