Abstract
Purpose: :
To evaluate the RPE in the active stage and the recovery stage of multiple evanescent white dot syndrome (MEWDS) using different retinal imaging methods.
Methods: :
Two patients with MEWDS underwent retinal imaging using fundus autofluoresence (FAF; excitation 480 nm, barrier filter 500 nm) and near-infrared autofluorescence (NIA; excitation 787 nm, barrier filter 800 nm) using a confocal scanning laser ophthalmoscope (HRA2, Heidelberg Engineering, Heidelberg, Germany) as well as spectral domain OCT (sdOCT; Spectralis OCT, Heidelberg Engineering, Heidelberg, Germany).
Results: :
In the acute stage of MEWDS, granular foveal changes correspond to markedly reduced NIA intensity and an interruption of the photoreceptor inner/outer segment layer in the sdOCT, whereas FAF alterations where limited. In contrast, the white flecks in the macula and mid-periphery can be better identified with FAF compared to NIA. FAF identifies several more flecks than are ophthalmoscopically visible. These flecks correspond to a small interruption in the photoreceptor inner/outer segment layer. During follow-up, foveal and peripheral structural integrity is reconstituted over a period of several months.
Conclusions: :
MEWDS affects the RPE and the photoreceptor inner/outer segment layer in the acute stage with reconstitution of the structural damage during the recovery phase. The resolution of FAF and NIA alterations indicates, that there is a limited change of RPE cell function, but no permanent damage to the RPE.
Keywords: retinal pigment epithelium • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • inflammation