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Marcela Marsiglia, Eduardo Cunha Souza, Sarah Mrejen, Thomas Arno Albini, Roberto Gallego-Pinazo, Suqin Yu, Alain Gaudric, K Bailey Freund, Lawrence A Yannuzzi, MEWDS Study Group; Analysis of Foveal Variability with Optical Coherence Tomography in Multiple Evanescent White Dot Syndrome. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5811.
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To investigate the spectrum of foveal changes observed by spectral domain optical coherence tomography (SD-OCT) in the multiple evanescent white dot syndrome (MEWDS).
This was a retrospective review of SD-OCT imaging for patients confirmed to have had a diagnosis of MEWDS through comprehensive ophthalmologic examination and multimodal retinal imaging. Foveal SD-OCT findings were analyzed by a team of retina specialists and compared to the SD-OCT changes previously described in MEWDS, and to the foveal changes described in other retinal diseases associated with acute damage to the outer retinal layers.
17 patients with mean age of 30.8 years old were included in this study. Of these patients, 15 were females (88.2%) and 2 were males (11.8%). Initial mean visual acuity was 20/50. SD-OCT analysis showed disruption of the ellipsoid zone and accumulations of hyper-reflective material that had variable size and shape. The variations in shape of the deposited material included dome shape deposits over the RPE band, linear thick vertical accumulations, linear vertical disrupted accumulations and irregular formations. The retinal layers affected were also variable with some of the hyper-reflective lesions lying over the RPE and others expanding towards the inner retina reaching the level of the outer nuclear layer (Figure 1). One patient experienced 3 recurrences. With each episode, SD-OCT revealed dome-shaped accumulations that varied in size and contour and were always lying above the RPE band (Figure 2). One case developed foveal fibrosis (figure 1, top right), which resulted in a transient visual decline to hand motion,with subsequent improvement to 20/200. The SD-OCT findings of MEWDS were compared to other retinal diseases with similar findings including solar maculopathy, poppers maculopathy, ellipsoid zone disruption due to intravitreal ocriplasmin injection, acute macular neuroretinopathy and multifocal choroiditis.
The spectrum of foveal SD-OCT findings observed in MEWDS is more varied than has been previously reported. Recognition of these patterns may be of help in the diagnosis of MEWDS and the assessment of visual prognosis.
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