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Song YY, Kim JT, Chang YS, Lee MW, Lee SC. Increased incidence and diverse manifestations of multiple evanescent white dot syndrome during the COVID-19 pandemic. Sci Rep 2024; 14:12425. [PMID: 38816508 PMCID: PMC11139874 DOI: 10.1038/s41598-024-63255-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024] Open
Abstract
The advent of coronavirus disease 2019 (COVID-19) pandemic has affected the incidence and course of various diseases and numerous studies have investigated ocular involvement associated with COVID-19 and corresponding vaccines. In this study, we compared the incidence of multiple evanescent white dot syndrome (MEWDS) before and during the COVID-19 pandemic at a single center in Korea and analyzed the demographic and clinical features of patients with MEWDS presenting during the COVID-19 pandemic. We categorized patients with MEWDS into two groups according to date of diagnosis. Pre-COVID19 group included patients diagnosed during the pre-pandemic period (between March 11, 2017, and March 10, 2020), whereas post-COVID19 group included patients diagnosed during the pandemic period (between March 11, 2020, and March 10, 2023). 6 and 12 patients were included in pre-COVID19 group and post-COVID19 group, respectively. Among all hospital visits during the pre-pandemic and pandemic periods, 0.011% and 0.030% were due to MEWDS, indicating a significant increase during the pandemic (p = 0.029, B = 2.756). The annual incidence of patients with MEWDS in 2017-2022 were 0.73, 0.75, 0.78, 1.32, 2.49, and 2.07 per 10,000 population, respectively, corresponding to a significant increase (p = 0.039, B = 1.316). Our results imply that the incidence and manifestation of MEWDS are likely to become more diverse in the COVID-19 pandemic era.
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Affiliation(s)
- Yong Yeon Song
- Onnuri Eye Hospital, #325 Baekje-daero, Jeonju, Republic of Korea.
| | - Jung Tae Kim
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Young Suk Chang
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Min-Woo Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
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Feo A, Stradiotto E, Sacconi R, Menean M, Querques G, Romano MR. Subretinal hyperreflective material in retinal and chorioretinal disorders: A comprehensive review. Surv Ophthalmol 2024; 69:362-377. [PMID: 38160737 DOI: 10.1016/j.survophthal.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 01/03/2024]
Abstract
Subretinal hyperreflective material (SHRM) is a common and remarkable optical coherence tomography (OCT) biomarker whose importance is emerging in several retinal and chorioretinal diseases, including age-related macular degeneration, central serous chorioretinopathy, polypoidal choroidal vasculopathy, pathologic myopia, posterior uveitis, vitelliform lesions and macular dystrophies, and rarer disorders. Multimodal imaging, also thanks to the introduction of OCT angiography, allowed a deeper characterisation of SHRM components and its morphological changes after treatment, suggesting its usefulness in clinical practice. We discuss and summarize the nature, multimodal imaging characteristics, and prognostic and predictive significance of SHRM in the different retinal and choroidal disorders in which it has been described.
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Affiliation(s)
- Alessandro Feo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy.
| | - Elisa Stradiotto
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy.
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Matteo Menean
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Mario R Romano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; Department of Ophthalmology, Eye Unit Humanitas Gavazzeni-Castelli, Via Mazzini 11, Bergamo, Italy.
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3
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Chen C, Cheng Y, Zhang Z, Zhang Y, Hou S, Wang G, Peng X. The multimodal imaging features and outcomes of multifocal choroiditis/punctate inner choroidopathy lesion with multiple evanescent white dot syndrome-like features: a retrospective study. BMC Ophthalmol 2024; 24:3. [PMID: 38166867 PMCID: PMC10763055 DOI: 10.1186/s12886-023-03277-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 12/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Multiple evanescent white dot syndrome (MEWDS)-like features is a rare condition triggered by a macular disease or iatrogenic injury, exhibiting MEWDS changes in the fundus. This study aims to describe the multimodal imaging features and outcomes of multifocal choroiditis/punctate inner choroidopathy (MFC/PIC) lesions with MEWDS-like features. METHODS Six cases were studied retrospectively. All cases were given regional and oral corticosteroids. RESULTS All cases showed an isolated juxtafoveal yellowish-white MFC/PIC lesion with disruption of RPE-Bruch's membrane-choriocapillaris complex (RPE-BM-CC), subretinal hyperreflective materials and choroidal thickening on optical coherence tomography. Two weeks after presentation, the grayish-white dots disappeared spontaneously and the corticosteroids were given. After four weeks, the ellipsoid zone (EZ) around the lesion and hyper-autofluorescence resolved. After 13 weeks, five cases showed shrinkage of the juxtafoveal lesion and restoration of foveal EZ. After six months, the juxtafoveal lesion became pigmented. Only one case developed type 2 choroidal neovascularization. CONCLUSIONS The clinical course of MEWDS-like manifestations is still evanescent in our cases. The yellowish-white juxtafoveal MFC/PIC lesions with disruption of RPE-BM-CC and choroidal thickening showed a well-controlled prognosis after corticosteroid treatment.
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Affiliation(s)
- Chunli Chen
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Yizhe Cheng
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhihan Zhang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Yang Zhang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
- Beijing Institute of Ophthalmology, Beijing, China
| | - Simeng Hou
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Ge Wang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Xiaoyan Peng
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China.
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4
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Cicinelli MV, Ramtohul P, Marchese A, Bandello F, Bailey Freund K, Miserocchi E, Jampol LM. Latest advances in white spot syndromes: New findings and interpretations. Prog Retin Eye Res 2023; 97:101207. [PMID: 37574123 DOI: 10.1016/j.preteyeres.2023.101207] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/15/2023]
Abstract
White spot syndromes (WSS) pose challenges in the field of ophthalmology, particularly in terms of accurate diagnosis and effective management. However, recent advancements in multimodal imaging (MMI) have significantly contributed to our understanding of WSS, allowing for improved characterization of these inflammatory chorioretinopathies. By employing various imaging modalities, including fundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence, optical coherence tomography (OCT), ultra-widefield imaging, and OCT angiography, researchers and clinicians have gained valuable insights into the underlying pathophysiological changes and clinical progression of WSS. Furthermore, MMI has unveiled novel and atypical variants within the spectrum of WSS, expanding our knowledge in this field. Notably, the identification of secondary forms of WSS occurring concurrently with unrelated chorioretinal disorders has suggested a potential autoimmune mechanism underlying these conditions. The introduction of MMI has also facilitated a more comprehensive evaluation of previously ill-defined entities, such as acute zonal occult outer retinopathy, leading to improved diagnostic criteria and enhanced recognition of distinct features. This review paper provides a comprehensive overview of the latest advances and interpretations in WSS. By integrating MMI into the diagnosis and management of these conditions, this review aims to enhance patient outcomes and provide valuable insights into the complexities surrounding WSS.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Prithvi Ramtohul
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; NYU Grossman School of Medicine, New York, NY, USA
| | - Alessandro Marchese
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; NYU Grossman School of Medicine, New York, NY, USA
| | - Elisabetta Miserocchi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lee M Jampol
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Meng Y, Zhang Q, Li L, Yi Z, Xu Y, Su Y, Liang C, Xiao D, Zhang L, Chen C. PRIMARY MULTIPLE EVANESCENT WHITE DOT SYNDROME AND MULTIPLE EVANESCENT WHITE DOT SYNDROME SECONDARY TO MULTIFOCAL CHOROIDITIS/PUNCTATE INNER CHOROIDOPATHY: A Comparative Study. Retina 2023; 43:1122-1131. [PMID: 36893447 DOI: 10.1097/iae.0000000000003776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE To present and compare the clinical features and multimodal imaging (MMI) findings of the primary form of multiple evanescent white dot syndrome (MEWDS) and MEWDS secondary to multifocal choroiditis/punctate inner choroidopathy (MFC/PIC). METHODS A prospective case series. Thirty eyes of 30 MEWDS patients were included and divided into the primary MEWDS group and MEWDS secondary to MFC/PIC group. Demographic, epidemiologic, and clinical characteristics and MEWDS-related MMI findings of the two groups were compared. RESULTS Seventeen eyes from 17 patients with primary MEWDS and 13 eyes from 13 patients with MEWDS secondary to MFC/PIC were evaluated. Patients with MEWDS secondary to MFC/PIC tended to have a higher degree of myopia than those with primary MEWDS. No other significant differences in demographic, epidemiologic, and clinical characteristics and MMI findings were found between the two groups. CONCLUSION "MEWDS-like reaction" hypothesis seems to be correct for MEWDS secondary to MFC/PIC, and the authors highlight the importance of MMI examinations in MEWDS. Further research is needed to confirm whether the hypothesis is applicable to other forms of secondary MEWDS.
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Affiliation(s)
- Yang Meng
- Eye Center, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Qi Zhang
- Department of Ocular Fundus Disease, Wuhan EyeGood Ophthalmic Hospital, Wuhan, China; and
| | - Lu Li
- Eye Center, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Zuohuizi Yi
- Eye Center, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Yishuang Xu
- Eye Center, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Yu Su
- Eye Center, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Congbi Liang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Di Xiao
- Eye Center, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Lu Zhang
- Department of Ophthalmology, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, China
| | - Changzheng Chen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, China
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Gallo B, Talks JS, Pandit RJ, Browning AC. Multiple Evanescent White Dot Syndrome and Choroidal Neovascularization following SARS-COV-2 Infection in a Patient on Dabrafenib and Trametinib. Ocul Immunol Inflamm 2022; 31:641-648. [PMID: 35226581 DOI: 10.1080/09273948.2022.2042320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE to describe multimodal imaging and electrophysiology of multiple evanescent white dot syndrome (MEWDS) concomitant with COVID-19 infection in a patient on BRAF (B Rapidly Accelerated Fibrosarcoma) and MEK (Mitogen-activated Protein Kinase) inhibitors. METHODS observational case report and literature review. RESULTS a 37-year-old woman affected by cutaneous melanoma on BRAF and MEK inhibitors developed visual symptoms in the right eye simultaneously with a SARS-COV-2 infection. The right eye visual acuity was hand movement, and clinical examination disclosed vitreous cells, yellow-white retinal spots, and macular yellowish material. Fundus autofluorescence and angiograms were consistent with MEWDS. Angiograms, optical coherence tomography, and optical coherence tomography angiography revealed a macular choroidal neovascular membrane. The infectious and inflammatory work-up was negative. Electrodiagnostic tests revealed cone dysfunction. MEWDS resolved and anti-VEGF treatment allowed partial vision recovery. CONCLUSION the case illustrates the association of MEWDS and choroidal neovascularization developing after COVID-19 infection in the setting of immunotherapy.
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Affiliation(s)
- Beatrice Gallo
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - James S Talks
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ranjeet J Pandit
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Andrew C Browning
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Essilfie J, Bacci T, Abdelhakim AH, Ramtohul P, Turchi F, Freund KB, Yannuzzi LA. ARE THERE TWO FORMS OF MULTIPLE EVANESCENT WHITE DOT SYNDROME? Retina 2022; 42:227-235. [PMID: 34432725 DOI: 10.1097/iae.0000000000003288] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the nature of multiple evanescent white dot syndrome (MEWDS) and differentiate an idiopathic or primary form of MEWDS from a secondary form that is seen in association with other clinical conditions affecting the posterior segment of the eye. METHODS Clinical and multimodal imaging findings including color fundus photography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography, spectral-domain optical coherence tomography, and optical coherence tomography angiography of patients with secondary MEWDS are presented. RESULTS Twenty consecutive patients with secondary MEWDS were evaluated. Fifteen patients were female. Most were young adults aged between 20 to 40 years with myopia (less than -6 diopters). Pathologic conditions associated with the secondary MEWDS reaction were high myopia (greater than -6 diopters) in two eyes, previous vitreoretinal surgery for rhegmatogenous retinal detachment in 2 eyes, and manifestations of multifocal choroiditis in 18 eyes. In all eyes, the MEWDS lesions followed a course of progression and resolution independent from the underlying condition. CONCLUSION Secondary MEWDS seems to be an epiphenomenon ("EpiMEWDS") that may be seen in association with clinical manifestations disruptive to the choriocapillaris-Bruch membrane-retinal pigment epithelium complex.
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Affiliation(s)
- Juliet Essilfie
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, Grossman School of Medicine, New York University, New York City, New York
- Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, New York
| | - Tommaso Bacci
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, Grossman School of Medicine, New York University, New York City, New York
| | - Aliaa H Abdelhakim
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, Grossman School of Medicine, New York University, New York City, New York
- Department of Ophthalmology, Manhattan Eye, Ear and Throat Hospital, New York, New York
- Irving Medical Center, Columbia University, Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, New York
| | - Prithvi Ramtohul
- Centre Hospitalier, Universitaire de l'Hopital Nord, Marseille, France
- Ophthalmology Department, Universite de Paris, AP-HP, Hopital Larboisiere, Paris, France
| | - Federica Turchi
- Policlinico San Orsola Malpighi, University of Bologna, Bologna, Italy; and
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, Grossman School of Medicine, New York University, New York City, New York
- Irving Medical Center, Columbia University, Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, New York
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York
| | - Lawrence A Yannuzzi
- Vitreous Retina Macula Consultants of New York, New York, New York
- Department of Ophthalmology, Grossman School of Medicine, New York University, New York City, New York
- Irving Medical Center, Columbia University, Edward S. Harkness Eye Institute, New York-Presbyterian Hospital, New York, New York
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York
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Papasavvas I, Mantovani A, Tugal-Tutkun I, Herbort CP. Multiple evanescent white dot syndrome (MEWDS): update on practical appraisal, diagnosis and clinicopathology; a review and an alternative comprehensive perspective. J Ophthalmic Inflamm Infect 2021; 11:45. [PMID: 34921620 PMCID: PMC8684571 DOI: 10.1186/s12348-021-00279-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple evanescent white dot syndrome (MEWDS) is a rare inflammatory eye condition affecting the outer retina as a consequence of choriocapillaris non perfusion. The pathophysiology of MEWDS will be discussed based clinical appraisal and on multimodal imaging appraisal. METHODS Narrative review and perspective opinion. RESULTS Literature review results helped us to put forward (1) the specific symptomatology (decreased/blurred vision, photopsia, subjective scotomas), (2) the ill-asserted character of clinical findings (foveal granularity, white dots in fundoscopy), (3) and the crucial importance of multimodal imaging with the diagnostic triad of ICGA hypofluorescent areas, BL-FAF hyperautofluorescent areas and loss/damage of IS/OS-ellipsoid zone on SD-OCT that characterise the disease and can practically help the clinician to diagnose MEWDS. A comprehensive alternative perspective of the disease was formulated. CONCLUSIONS The bulk of evidence that we are presenting in this review, thanks to new performing non-invasive and invasive imaging modalities, is sufficiently compelling to consider MEWDS as a primary choriocapillaritis/inflammatory choriocapillaropathy. Multimodal imaging allows the clinician to diagnose MEWDS with a high level of certainty and ensures a precise follow-up.
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Affiliation(s)
- Ioannis Papasavvas
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Rue Charles-Monnard 6, CH-1003, Lausanne, Switzerland.
| | | | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Carl P Herbort
- Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care (COS), Clinic Montchoisi Teaching Centre, Rue Charles-Monnard 6, CH-1003, Lausanne, Switzerland.
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Azar G, Bonnin S, Vasseur V, Faure C, Salviat F, Clermont CV, Titah C, Farès S, Boulanger E, Derrien S, Couturier A, Duvilliers A, Manassero A, Hage R, Tadayoni R, Behar-Cohen F, Mauget-Faÿsse M. Did the COVID-19 Pandemic Increase the Incidence of Acute Macular Neuroretinopathy? J Clin Med 2021; 10:jcm10215038. [PMID: 34768555 PMCID: PMC8585041 DOI: 10.3390/jcm10215038] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/23/2021] [Accepted: 10/27/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Acute macular neuroretinopathy (AMN) is an increasingly diagnosed disorder associated with several diseases. The aim of this study was to report the incidence of AMN cases diagnosed during the 2020 coronavirus disease 2019 (COVID-19) pandemic year in a French hospital, and to describe their different forms. Methods: All patients diagnosed between 2019 and 2020, in Paris Rothschild Foundation Hospital, with AMN, paracentral acute middle maculopathy (PAMM) and multiple evanescent white dot syndrome (MEWDS) were retrospectively collected using the software Ophtalmoquery® (Corilus, V1.86.0018, 9050 Gand, Belgium). Systemic and ophthalmological data from AMN patients were analyzed. Results: Eleven patients were diagnosed with AMN in 2020 vs. only one patient reported in 2019. The incidence of AMN significantly increased from 0.66/100,000 visits in 2019 to 8.97/100,000 visits in 2020 (p = 0.001), whereas the incidence of PAMM and MEWDS remained unchanged. Four (36%) of these AMN patients were tested for COVID-19 and received positive polymerase chain reaction (PCR) tests. Conclusions: The incidence of AMN cases increased significantly in our institution in 2020, which was the year of the COVID-19 pandemic. All AMN-tested patients received a positive COVID PCR test, suggesting a possible causative link. According to the different clinical presentations, AMN may reflect different severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pathogenic mechanisms.
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Affiliation(s)
- Georges Azar
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
- Anterior Segment Department, Adolphe de Rothschild Foundation, 75019 Paris, France
- Correspondence:
| | - Sophie Bonnin
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Vivien Vasseur
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Céline Faure
- Ramsay Générale de Santé, Private Hospital Saint Martin, 14000 Caen, France;
| | - Flore Salviat
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Catherine Vignal Clermont
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Cherif Titah
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
- Anterior Segment Department, Adolphe de Rothschild Foundation, 75019 Paris, France
| | - Selim Farès
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
- Anterior Segment Department, Adolphe de Rothschild Foundation, 75019 Paris, France
| | - Elise Boulanger
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Sabine Derrien
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Aude Couturier
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
- Ophthalmology Department, Lariboisière Hospital—Assistance Publique-Hôpitaux de Paris, AP-HP, 75010 Paris, France
| | - Amélie Duvilliers
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Anthony Manassero
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Rabih Hage
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
| | - Ramin Tadayoni
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
- Ophthalmology Department, Lariboisière Hospital—Assistance Publique-Hôpitaux de Paris, AP-HP, 75010 Paris, France
| | - Francine Behar-Cohen
- Ophthalmology Department, OphtalmoPôle, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, 75014 Paris, France;
- Centre de Recherche des Cordeliers, Team 17, INSERM U1138, Université de Paris, 75006 Paris, France
| | - Martine Mauget-Faÿsse
- Clinical Investigative Platform Department, Adolphe de Rothschild Foundation, 75019 Paris, France; (S.B.); (V.V.); (F.S.); (C.V.C.); (C.T.); (S.F.); (E.B.); (S.D.); (A.C.); (A.D.); (A.M.); (R.H.); (R.T.); (M.M.-F.)
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PRESUMED FOVEAL BACILLARY LAYER DETACHMENT IN A PATIENT WITH TOXOPLASMOSIS CHORIORETINITIS AND PACHYCHOROID DISEASE. Retin Cases Brief Rep 2021; 15:391-398. [PMID: 30142112 DOI: 10.1097/icb.0000000000000817] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a detachment that apparently separated photoreceptor inner segment myoids from inner segment ellipsoids as a manifestation of toxoplasmosis chorioretinitis in a patient with pachychoroid spectrum disease. METHODS Multimodal imaging including fundus photography, spectral domain and enhanced-depth imaging optical coherence tomography (OCT), indocyanine green angiography, and OCT angiography. RESULTS A 33-year-old man with a history of toxoplasmosis chorioretinitis reported 1 week of decreased vision to 20/200 in his right eye. Examination of the right eye demonstrated mild vitritis with recurrent chorioretinitis inferior to the fovea and adjacent to a chorioretinal scar. A dome-shaped, foveal photoreceptor layer-splitting detachment was noted on OCT. Because degenerating cone photoreceptors are capable of shedding their inner segments, we inferred the location of the detachment at the level of the inner segment myoid and provided a histological example of such from an unrelated donor case. In addition, multimodal imaging revealed dilated choroidal veins (pachyvessels) with attenuation of the inner choroid in both eyes and asymptomatic findings of central serous chorioretinopathy in the left eye. After 1 month of antibiotic and steroid therapy, the chorioretinitis resolved, as did the detachment. Hyperreflective foci on the vitreoretinal interface were appreciated with en face OCT that appeared to aggregate throughout the course of therapy, induce inner retinal striae, and resolve without inducing epiretinal membrane formation. CONCLUSION Patients with preexisting pachychoroid spectrum disease may manifest a more significant retinal fluid accumulation in the setting of superimposed chorioretinal inflammation. In this case of macular toxoplasmosis chorioretinitis, inflammation manifested as a retinal detachment at the level of photoreceptor inner segment myoids that we named as a bacillary layer detachment. In this case, inflammatory sequelae of toxoplasmosis reactivation responded well to oral and intravitreal therapy.
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DIFFERENTIAL RESPONSE TO GLUCOCORTICOID IMMUNOSUPPRESSION OF TWO DISTINCT INFLAMMATORY SIGNS ASSOCIATED WITH PUNCTATE INNER CHOROIDOPATHY. Retina 2021; 41:812-821. [PMID: 32804829 DOI: 10.1097/iae.0000000000002950] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe the differential response of two distinct inflammatory signs occurring in eyes with punctate inner choroidopathy. METHODS Retrospective, observational case series using multimodal imaging. RESULTS Four eyes of 4 myopic female patients (mean age of 35 years, range 31-42 years) presenting with retinal manifestations of punctate inner choroidopathy. All study eyes had 2 distinct signs of active disease: 1) acute focal hyperreflective lesions splitting the retinal pigment epithelium/Bruch membrane complex on optical coherence tomography which appeared hypoautofluorescent on fundus autofluorescence and 2) more diffuse areas of outer retinal disruption limited to the ellipsoid zone and interdigitation zone on optical coherence tomography and corresponding to hyperautofluorescence on fundus autofluorescence. All patients were treated with oral prednisone and demonstrated prompt regression of the retinal pigment epithelium/Bruch membrane complex lesions with a concurrent, paradoxical centrifugal expansion of outer retinal disruption. The outer retinal disruption eventually resolved in all eyes (mean time of 6 weeks, range 4-10 weeks). CONCLUSION In patients with punctate inner choroidopathy, two distinct inflammatory signs observed with multimodal imaging display a differential response to systemic corticosteroids. Although focal inflammatory lesions splitting the retinal pigment epithelium/Bruch membrane complex seem to respond rapidly, the more diffuse, transient outer retinal disruption shows little response. This difference in treatment response may reflect different immunological phenomena with independent natural history.
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Bosello F, Westcott M, Casalino G, Agorogiannis G, Micciolo R, Rees A, Pavesio C. Multiple evanescent white dot syndrome: clinical course and factors influencing visual acuity recovery. Br J Ophthalmol 2020; 106:121-127. [DOI: 10.1136/bjophthalmol-2020-317357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 01/13/2023]
Abstract
ObjectiveTo report the demographics and the clinical course of patients with multiple evanescent white dot syndrome (MEWDS) and to investigate for those factors which influence visual acuity (VA) recovery.MethodsThis is a retrospective single-centre observational study. Electronic medical records and retinal imaging of patients with a diagnosis of MEWDS with a minimum follow-up of 3 months were reviewed. Patients were categorised into three groups according to the VA at presentation and at the last visit: group 1 >0.48 logarithm of the minimum angle of resolution (LogMAR), group 2 ≤0.48 and ≥0.18 LogMAR and group 3 <0.18 LogMAR. All patients had non-invasive multimodal imaging including optical coherence tomography, near-infrared reflectance imaging and blue fundus autofluorescence at presentation and during follow-up.ResultsA total of 51 eyes from 51 patients (41 women, mean age 29.8±7.8 years) were included. Significantly more patients presented in the autumn (X2=8.69, p=0.034). The percentage of eyes recovering vision to 0.0 LogMAR or better was 80.3% (41/51). Worse presenting vision and young age at presentation were independent significant predictive variables for poorer final VA (p=0.002 and p=0.02, respectively). No imaging features were significantly predictive of complete versus incomplete recovery, but disc hyperfluorescence on fluorescein angiography was more common in those with incomplete recovery.ConclusionsAlthough the majority of cases have a benign prognosis, the clinical spectrum of MEWDS includes incomplete visual recovery. In our series, poor presenting VA and young age were associated with poor VA outcome. Further study is warranted to confirm these findings.
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Russell JF, Pichi F, Scott NL, Hartley MJ, Bell D, Agarwal A, Leong B, Holland GN, Freund KB, Sarraf D. Masqueraders of multiple evanescent white dot syndrome (MEWDS). Int Ophthalmol 2019; 40:627-638. [DOI: 10.1007/s10792-019-01223-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 11/24/2022]
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15
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Witkin AJ. Potentially Novel Acute Retinopathy Similar to Multiple Evanescent White Dot Syndrome in Patients With Pseudoxanthoma Elasticum. JAMA Ophthalmol 2019; 137:1173-1174. [DOI: 10.1001/jamaophthalmol.2019.2884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andre J. Witkin
- Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts
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Morizot E, Schiavo Froner C. Neovessel as first manifestation of relapse of associated multifocal choroiditis and MEWDS. Int J Retina Vitreous 2019; 5:25. [PMID: 31516733 PMCID: PMC6734253 DOI: 10.1186/s40942-019-0175-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/25/2019] [Indexed: 11/10/2022] Open
Abstract
Purpose To report a case of multifocal choroiditis (MC) that has relapsed as choroidal neovascularization in the contralateral eye followed by a mixed aspect of multiple evanescent white dot syndrome (MEWDS) and MC. Methods Retrospective case report and literature review. The clinical findings were documented by fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography (OCT-A). Results The authors describe the case of a 39-year-old woman with prior ocular history of presumed MEWDS in her left eye, which developed into MC 7 years later in the same eye and 11 years later in the right eye, starting as choroidal neovascularization and developing into MEWDS. OCT-A showed neovessel in a supposedly active MC area outside the macular region in right and left eyes. OCT showed increased choroidal thickness in both eyes and a choroidal neovascularization in the right eye, treated using anti- VEGF therapy. Conclusion This case corroborates the proximity of some inflammatory diseases such as MC and MEWDS. OCT-A has opened new horizons for the better understanding of some retinal diseases by providing more thorough and promising morphological analyses using enhanced tools.
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Affiliation(s)
- Eduardo Morizot
- Policlínica de Botafogo, Av. Pasteur, 72 - Botafogo, Rio de Janeiro, Brazil.,Institute Benjamin Constant, Av. Pasteur, 350 - Urca, Rio de Janeiro, Brazil
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Savastano MC, Rispoli M, Lumbroso B. Choroidal juxtapapillary neovascularization regression in multiple evanescent white dot syndrome by optical coherence tomography angiography: a case report. J Med Case Rep 2019; 13:274. [PMID: 31470898 PMCID: PMC6717392 DOI: 10.1186/s13256-019-2211-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple evanescent white dot syndrome most often resolves spontaneously without complications; however, choroidal neovascularization can sometimes occur. CASE PRESENTATION Here, we describe a case of a 22-year-old white Caucasian man with blurred vision in his left eye who exhibited juxtapapillary choroidal neovascularization on optical coherence tomography angiography. Although multiple evanescent white dot syndrome is often self-limiting, to reduce the possibility of an inflammatory reaction, we preferred to administer prednisolone orally. After 3 months, significant regression of juxtapapillary neovascularization was observed by B-scan and optical coherence tomography angiography. Symptoms resolved in 3 months. A steady situation was observed at 4 years of follow-up. CONCLUSION This case report highlights the helpful use of optical coherence tomography angiography in daily clinical practice, even in inflammatory diseases, such as atypical juxtapapillary neovascularization in multiple evanescent white dot syndrome. Choroidal neovascularization associated with multiple evanescent white dot syndrome by means of optical coherence tomography angiography showed neovascular activity regression, thus avoiding invasive therapy.
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Affiliation(s)
| | - Marco Rispoli
- Centro Italiano Macula, Via Angelo Brofferio, 7, 00196, Rome, Italy
| | - Bruno Lumbroso
- Centro Italiano Macula, Via Angelo Brofferio, 7, 00196, Rome, Italy
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Tan ACS, Tan GS, Denniston AK, Keane PA, Ang M, Milea D, Chakravarthy U, Cheung CMG. An overview of the clinical applications of optical coherence tomography angiography. Eye (Lond) 2018; 32:262-286. [PMID: 28885606 PMCID: PMC5811700 DOI: 10.1038/eye.2017.181] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/15/2017] [Indexed: 12/15/2022] Open
Abstract
Optical coherence tomography angiography (OCTA) has emerged as a novel, non-invasive imaging modality that allows the detailed study of flow within the vascular structures of the eye. Compared to conventional dye angiography, OCTA can produce more detailed, higher resolution images of the vasculature without the added risk of dye injection. In our review, we discuss the advantages and disadvantages of this new technology in comparison to conventional dye angiography. We provide an overview of the current OCTA technology available, compare the various commercial OCTA machines technical specifications and discuss some future software improvements. An approach to the interpretation of OCTA images by correlating images to other multimodal imaging with attention to identifying potential artefacts will be outlined and may be useful to ophthalmologists, particularly those who are currently still unfamiliar with this new technology. This review is based on a search of peer-reviewed published papers relevant to OCTA according to our current knowledge, up to January 2017, available on the PubMed database. Currently, many of the published studies have focused on OCTA imaging of the retina, in particular, the use of OCTA in the diagnosis and management of common retinal diseases such as age-related macular degeneration and retinal vascular diseases. In addition, we describe clinical applications for OCTA imaging in inflammatory diseases, optic nerve diseases and anterior segment diseases. This review is based on both the current literature and the clinical experience of our individual authors, with an emphasis on the clinical applications of this imaging technology.
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Affiliation(s)
- A C S Tan
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Singapore Eye Research Institute, Singapore Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - G S Tan
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Singapore Eye Research Institute, Singapore Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - A K Denniston
- Department of Ophthalmology, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - P A Keane
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - M Ang
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Singapore Eye Research Institute, Singapore Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - D Milea
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Singapore Eye Research Institute, Singapore Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - U Chakravarthy
- Department of Ophthalmology, Queen's University of Belfast, Royal Victoria Hospital, Belfast, Northern Ireland
| | - C M G Cheung
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Singapore Eye Research Institute, Singapore Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Mathis T, Delaunay B, Cahuzac A, Vasseur V, Mauget-Faÿsse M, Kodjikian L. Choroidal neovascularisation triggered multiple evanescent white dot syndrome (MEWDS) in predisposed eyes. Br J Ophthalmol 2017; 102:971-976. [DOI: 10.1136/bjophthalmol-2017-311005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/07/2017] [Accepted: 09/14/2017] [Indexed: 11/03/2022]
Abstract
BackgroundMultiple evanescent white dot syndrome (MEWDS) is an inflammatory disease that can be associated with choroidalneovascularisation (CNV). However, few studies in the literature have described the occurrence of MEWDS in association with CNV. This paper discusses whether CNV can trigger MEWDS in a predisposed eye.MethodsA retrospective multicentric case series of six eyes in six patients with acute onset of MEWDS and evidence of previous CNV was conducted between January 2015 and January 2017. All patients underwent ophthalmic examination including multimodal imaging at baseline and during follow-up.ResultsThe mean age was 32.2±12.2 years. The majority of patients were women (5/1). In each case, MEWDS was diagnosed during a recurrence or occurrence of CNV secondary to choriocapillaritis, central serous chorioretinopathy or atrophic scar, presumably due to congenital toxoplasmosis. All patients were treated with intravitreal injections of antivascular endothelial growth factor (anti-VEGF) with good anatomical and functional responses (mean gain of 0.3±0.31logMAR). The mean duration of follow-up was 13.5±10.65 months.ConclusionThis study highlights a sequence in the development of MEWDS, following the occurrence or recurrence of CNV. CNV may trigger MEWDS, possibly due to the proinflammatory environment created by the retinal tissue surrounding the CNV.
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