March 2012
Volume 53, Issue 14
Free
ARVO Annual Meeting Abstract  |   March 2012
Widespread Disruption of Photoreceptor Segments with Focal Elevation of RPE as a Pathogenetic Implication in MEWDS; Time-periodic Evidence by Multi-modal Imaging
Author Affiliations & Notes
  • Byung Ro Lee
    Ophthalmology, Hanyang Univ Hosp, Seoul, Republic of Korea
  • Won June Lee
    Ophthalmology, Hanyang Univ Hosp, Seoul, Republic of Korea
  • Yong Un Shin
    Ophthalmology, Hanyang Univ Hosp, Seoul, Republic of Korea
  • Footnotes
    Commercial Relationships  Byung Ro Lee, B.R. Lee is the consultant of Nidek (C); Won June Lee, None; Yong Un Shin, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 2081. doi:
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      Byung Ro Lee, Won June Lee, Yong Un Shin; Widespread Disruption of Photoreceptor Segments with Focal Elevation of RPE as a Pathogenetic Implication in MEWDS; Time-periodic Evidence by Multi-modal Imaging. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2081.

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Abstract

Purpose: : To determine the exact location of lesions and evaluate time-periodic changes in multiple evanescent white dot syndrome (MEWDS) with the aid of spectral domain optical coherence tomography(SD-OCT), fundus autofluorescence(FAF) and indocyanine green angiography(ICGA).

Methods: : Serial SD-OCT, FAF and ICGA were undertaken simultaneously at diagnosis until clinical resolution in a 36-year-old woman with MEWDS. In depth correlation between SD OCT, FAF and ICGA according to disease course were performed. The interpretation for possible pathophysiology of MEWDS was made with correlation of multiple image modalities and literature reviews.

Results: : In the acute phase, SD-OCT revealed widespread disruptions of the junction between photoreceptor inner and outer segments(IS/OS) with focal diffuse retinal pigment epithelium(RPE) elevation. FAF revealed diffuse generalized hyperautofluorescent areas. These findings corresponded precisely to the site of the diffuse generalized hypofluorescent spots seen on ICGA. During the recovery phase, disrupted IS/OS junction and was repaired considerably and some of RPE elevation remained on SD-OCT. FAF revealed considerable shrinkage of generalized hyperautofluorescent areas and more discrete hyperautofluorescent, which corresponded precisely to the site of remnant of focal RPE elevation on SD-OCT. In the fully resolution phase, there were no RPE-Photoreceptor abnormalities observed on SD-OCT. On FAF, the intensity and size of hyperautofluorescent dots was almost normalized and some of them converted to hypoautofluorescent dots.

Conclusions: : These detailed serial simultaneous description of SD-OCT and FAF finding have yet been reported before. We can confirm the widespread disruption of photoreceptor segments with focal elevation of RPE as a pathogenetic implication in MEWDS with the aid of multi-modal imaging, which do not represent choroidal lesions.

Keywords: imaging/image analysis: clinical • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) 
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