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John Legarreta, Andrew Legarreta, Zach Nadler, Leanne Labriola; Photoreceptor Changes on Multi-Modal Adaptive-Optics Imaging Correlate with Transient Abnormalities on Autofluorescence and Indocyanine Green Angiography in a Patient with Multiple Evanescent White Dot Syndrome. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5861.
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© ARVO (1962-2015); The Authors (2016-present)
To use multimodal imaging to identify and characterize outer retinal changes in a patient with multiple evanescent white dot syndrome (MEWDS).
One eye of a patient with MEWDS was imaged using a multimodal retinal imaging system with adaptive optics (Physical Sciences Inc.; Andover MA), which includes both spectral domain optical coherence tomography (AO-OCT) and confocal scanning laser ophthalmoscopy (AO-cSLO) imaging channel as well as fundus photography, indocyanine green angiography (ICG) and with blue light fundus autofluorescence (FAF). The OCT channel uses a 1050 nm super luminescent diode source with a bandwidth of 85 nanometers. All scans were obtained at baseline and then three months later.
At baseline, the images from fundus photography showed unilateral foveal granularity typical of MEWDS. The AO-OCT and AO-cSLO showed disruption in the photoreceptor layer. The AO-OCT displayed a break in the integrity of the inner segment epllisoid on b-scan images and the AO-cSLO confirmed the extent of the change on en-face imaging of the photoreceptor mosaic. In these scans, the abnormality was delineated by a loss of individual resolution of photoreceptors. The FAF and ICG images showed disruption in deeper structures underlying the photoreceptor changes. The FAF showed areas of increased autofluorescence signaling within the retinal pigment epithelium and the ICG images showed blocked signal of dye in the choroidal vasculature, presumably from choroidal inflammation. The follow up images confirmed complete resolution of all changes at each layer.
Multimodal imaging in this case of MEWDS displays that the pathology involves the photoreceptors as well as the retinal pigment epithelium and choroid. Each layer seems to be effected simultaneous and all changes resolve with observation which correlates with the resolution of symptoms experienced by the patient. Multimodal imaging may be used to better understand the disease pathology.
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