Multifocal evanescent white dot syndrome following inflammatory and myopic choroidal neovascularization

Abstract

Purpose : The aetiology of multifocal evanescent white dot syndrome (MEWDS) remains unclear. We present the observation of MEWDS developing after the onset choroidal neovascularization (CNV) in a series of patients.

Methods : Three patients presented to Moorfields Eye Hospital for the management of CNV in the context of myopia (1 patient) or punctate inner choroidopathy (PIC). Patients were assessed clinically, with funuds autofluorescence (FAF) and with spectral domain(SD)-OCT. In selected cases fluorescein and indocyanine green angiography were performed where indicated.

Results : In time-periods ranging from days to 12 weeks from the diagnosis of active CNV, MEWDS-type FAF and spectral SD-OCT changes were observed. An example of this sequence is presented for in Figure 1. Resolution of the MEWDS lesions occured in all cases and treatment with anti-vascular endothelial growth factor(VEGF) agents were instituted in 2 cases. In one case anti-VEGF therapy was not used for a CNV reactivation as there was a discifrom scar in the fovea with established poor vision. Nonetheless MEWDS developed in that case.

Conclusions : It was previously reported that the development of MEWDS can occur following the development of inflammatory CNVM, however this report expands the spectrum to the occurence following myopic CNV. Furthermore it may occur in those that were or were not treated with anti-VEGF therapy. The exact mechanistic relationship between CNVM activity and the development of MEWDS requires further study.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Figure 1. Imaging from baseline to final review for the right eye of Patient 1. Baseline fluorescein angiography (A1-3) imaging reveals a classic choroidal neovascular membrane in a myopic patient without signs of inflammation. Fundus autofluorescence (FAF, B1) and spectral domain-OCT (SD-OCT, B2) imaging at baseline revealed central macular atrophy and sub-retinal fluid with hyper-reflective subretinal material in the foveal region. 3 months from baseline and 1 month following 2^nd Ranibizumab injection, FAF (C1) revealed patchy diffuse hyperAF lesions in keeping with multifocal evanescent white dot syndrome. SD-OCT (C2) revealed resolution of SRF with focal discontinuities of the inner segment ellipsoid zone and hyper-reflective material within the outer nuclear later (red arrow). 13 months from presentation, the MEWDS FAF (D1) and SD-OCT (D2) lesions had resolved and the CNVM was quiescent.