Multimodal imaging findings in ‘hyper-early’ stage MEWDS

Cahuzac, Armelle; Wolff, Benjamin; Mathis, Thibaud; Errera, Marie‐Hélène; Sahel, José‐Alain; Mauget‐Faÿsse, Martine

doi:10.1136/bjophthalmol-2016-309175

Cited by 18 publications

(12 citation statements)

References 13 publications

(13 reference statements)

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“…However, there are signs that support the diagnosis. The symptoms and signs of this case as well as the auxiliary examinations are consistent with the characteristic of MEWDS: photopsia, disruption of the ellipsoid zone and the interdigitation layer at the center of the fovea, which is coincidence with what was observed by Cahuzac et al [ 8 ], multifocal hyperautofluorescent lesions at posterior pole and midperiphery, visual field defect corresponding the outer retinal abnormalities. Follow up the entire course of this case revealed complete recovery of the macular and retinal structures and function consistent the natural history of MEWDS.…”

Section: Discussionsupporting

confidence: 90%

Multiple evanescent white dot syndrome following rabies vaccination: a case report

Yang¹,

Chen

et al. 2018

BMC Ophthalmol

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BackgroundTo report a case of multiple evanescent white dot syndrome (MEWDS) following simultaneous rabies vaccination.Case presentationReview of the clinical, laboratory, photographic, optical coherence tomographic (OCT), fundus autofluorescent, angiographic, electrophysiologic, and perimetric records of a patient suffering from MEWDS. Results: A healthy 33-year-old Chinese female suffering from rapidly progressive visual loss of her left eye associated with photopsia and a para-central scotoma, seven days after receiving simultaneous rabies vaccination. Both anterior segments and fundus examination were unremarkable. The findings on OCT, electrophysiology, and perimetry were pathognomonic for MEWDS.ConclusionsThe clinical presentation and the benign course were consistent with the diagnosis of MEWDS. No other events could be identified as a cause, other than the rabies vaccination. This case may suggest an autoimmune basis for MEWDS in predisposed patients.

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Section: Discussionsupporting

confidence: 90%

Multiple evanescent white dot syndrome following rabies vaccination: a case report

Yang¹,

Chen

et al. 2018

BMC Ophthalmol

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“…Moreover, multimodal imaging is often scheduled a few days later. Cahuzac et al [10] reported 4 patients seen within 1 week of onset. They suggested that ellipsoid zone disruption starts simultaneously around the optic nerve and in a very restricted submacular area before extending diffusely.…”

Section: Discussionmentioning

confidence: 99%

Early Progressive Circumpapillary Lesion as Atypical Presentation of Multiple Evanescent White Dot Syndrome: A Case Report

Vela

Passabosc

Calvo

2020

Case Rep Ophthalmol

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Classical clinical findings of multiple evanescent white dot syndrome (MEWDS) include multiple, small white dots scattered throughout the posterior pole, foveal granularity, posterior vitreous cells, and mild optic disc swelling. We describe the case of a 35-year-old man who was admitted to our department with an unusual presentation of MEWDS at the early onset of the disease. A unilateral circumpapillary retinal white spot was observed. Spectral domain optical coherence tomography demonstrated irregularities of the retinal pigment epithelium and disruptions of the outer retinal layers around the optic nerve without other abnormalities. A few days later, the lesion spread centrifugally from the peripapillary region and along the vascular arcades. This distinctive appearance in an early stage of the disease may suggest a disorder other than MEWDS, which can lead to a misdiagnosis and unnecessary treatment.

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“…The diagnosis of MEWDS may be challenging because the lesions are frequently discrete with a characteristic spontaneous resolution [ 1 – 3 ]. The typical MEWDS lesions are observed as deep white spots in the peripapillary and macular areas, according to the natural course of the disease, these lesions disappear and the visual acuity improves to 20/20 during the follow-up period.…”

Section: Discussionmentioning

confidence: 99%

“…Other less common fundus features include an edematous appearing optic disc and the presence of cells in the vitreous. The majority of MEWDS patients present a spontaneous resolution of all lesions and improvement in visual acuity within weeks [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although the precise pathogenesis of MEWDS is unknown, an infectious etiology is thought to be involved in the pathogenesis of the disease since usually a viral prodrome exists [ 1 – 3 ]. The multimodal imaging analysis is very important to study patients with MEWDS because its clinical appearance may be indistinct from other white-dot syndromes.…”

Section: Introductionmentioning

confidence: 99%

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Swept-source OCT in patients with multiple evanescent white dot syndrome

Pereira

Lima

Azevedo

et al. 2018

J Ophthal Inflamm Infect

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BackgroundSwept-source optical coherence tomography (SS-OCT) has a higher scanning rate and longer wavelength in comparison with spectral-domain OCT (SD-OCT), allowing an improved imaging of retinal vascular plexuses and choriocapillaris. The present two patients diagnosed with multiple evanescent white dot syndrome (MEWDS) underwent fundus autofluorescence (FAF), en-face SS-OCT, and SS-OCT angiography (OCTA) imaging, and its features were described and correlated.ResultsThe clinical and imaging findings of both cases were consistent with the diagnosis of MEWDS. Color fundus photograph revealed subtle deep retinal white spots in the posterior pole and around the optic disk. FAF showed several hyperautofluorescent lesions corresponding topographically to the subtle deep retinal white lesions observed on color fundus photographs. Cross-sectional SS-OCT showed disruption of the ellipsoid zone (EZ) within the macular area in all study patients. En-face SS-OCT at the level of the outer retina showed lower reflectivity correspondent to the diffuse attenuation due to the EZ disruption on cross-sectional OCT. SS-OCTA demonstrated flow preservation within the retinal vasculature and choriocapillaris.ConclusionsSS-OCT imaging allows a better visualization of the choriocapillaris, and its normal appearance in MEWDS may suggest that the outer retina and photoreceptors represent the primary site of inflammation.

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Multimodal imaging findings in ‘hyper-early’ stage MEWDS

Abstract: We have shown a new feature of MEWDS on FAF, OCT, FA and ICGA, corresponding to a very early stage of the disease.

Cited by 18 publications

References 13 publications

Multiple evanescent white dot syndrome following rabies vaccination: a case report

Multiple evanescent white dot syndrome following rabies vaccination: a case report

Early Progressive Circumpapillary Lesion as Atypical Presentation of Multiple Evanescent White Dot Syndrome: A Case Report

Swept-source OCT in patients with multiple evanescent white dot syndrome

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