Macular edema in multiple evanescent white dot syndrome

Abstract

Eletroretinographic findings show that the transient decreased vision seen in patients with the multiple evanescent white dot syndrome (MEWDS) is related to metabolic disturbances at the level of the retinal pigment epithelium and photoreceptor complex. In this paper, we present a patient with a typical picture of MEWDS associated to macular edema, which could also be a factor to reduce vision in this disorder. Case report of a 53-year-old woman complaining about unilateral decreased vision of 7 days' duration was sent to our retina clinic. A complete ophthalmic examination was performed as well as fluorescein angiography, indocyanine green angiography, Goldmann visual fields and optical coherence tomography (OCT). Best-corrected visual acuity was 20/ 40 and 20/20, in the right and left eye respectively. Ophthalmoscopy of the affected eye revealed multiple focal outer retinal gray lesions in the perimacular and peripapillary region. There were several orange puntate lesions in the foveolar region. Fluorescein angiography disclosed faint multiple foci of staining in the perimacular and peripapillary area, and some staining of the optic disc. A discrete hyperfluorescence was also observed in the foveal region. OCT disclosed an increase in foveal thickness (231 µm), approximately 25% thicker than the opposite normal eye (186 µm). Within 3 months her visual acuity had returned to 20/20 and the foveal thickness returned to a normal value (189 ìm). Although the mechanism of transitory blurred vision is not completely elucidated in cases of MEWDS, we suggest that macular edema may play a role.