Imaging features of ultra-wide field fundus autofluorescence in multiple evanescent white dot syndrome_Chinese Journal of Ocular Fundus Diseases

Authors：

ChenRu ,  YuSuqin , ZouWenjun , YangJie

Department of Ophthalmology, Shanghai Jiaotong University Affiliated Shanghai First People's Hospital, Shanghai 200080, China;

Corresponding author：

YuSuqin, Email: sq-yu@163.com

Keywords：

Retinal diseases/diagnosis; Fluorescein angiography; Indocyanine green; Tomography, optical coherence; Diagnostic imaging

DOI：

10.3760/cma.j.issn.1005-1015.2016.03.006

Video：

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Objective To observe the imaging features of ultra-wide field short wave fundus autofluorescence (SW-FAF) in eyes with multiple evanescent white dot syndrome (MEWDS), and analysis the correspondence to conventional images. Methods It was a retrospective case series study. Thirteen patients (14 eyes) diagnosed with MEWDS were enrolled. There were 12 females and 1 male, aged from 22 to 57 years, mean age was 34.5 years. All the eyes underwent fundus color photography, optical coherence tomography (OCT) and ultra-wide field autofluorescence (FAF). Simultaneous fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed in 6 eyes. The characteristic changes of SW-FAF in studied eyes were observed and compared with the images of FFA and ICGA. All the eyes were followed up every 1 to 2 weeks, with an average of 16.7 weeks. The characteristic images of SW-FAF and corresponding OCT were studied during follow up. Results MEWDS presented with numerous multiple hyper-autofluorescent spots, sized from 50-500 μm, with a vague boundary in ultra-wide field SW-FAF. These spots located mainly at the peripapillary area and the posterior pole with a confluent pattern. The lesions extended to the mid-peripheral retina as well and became more scattered. The distribution of the hyper-autofluorescent lesions in SW-FAF corresponded roughly to that of the greyish-white spots seen in color photograph and the hyper-fluorescent spots detected by FFA. It was consistent with the distribution of hypo-fluorescent spots in late-phase ICGA as well. But the number of the spot showed in FAF is much more than that in FFA, and slightly less than that in ICGA. The OCT scans through the hyper-autofluorescent lesions in SW-FAF showed impairment of outer retina. After the recovery, the hyper-autofluorescent spots disappeared with the outer retina structure repaired completely. Conclusions MEWDS presented with numerous multiple hyper-autofluorescent spots which located mainly at the peripapillary area in ultra-wide field SW-FAF. The distribution of the hyper-autofluorescent lesions in SW-FAF corresponded roughly to color photograph, FFA and ICGA in late-phase. The OCT scans through the hyper-autofluorescent lesions in SW-FAF showed impairment of outer retina.

Citation： ChenRu, YuSuqin, ZouWenjun, YangJie. Imaging features of ultra-wide field fundus autofluorescence in multiple evanescent white dot syndrome. Chinese Journal of Ocular Fundus Diseases, 2016, 32(3): 252-256. doi: 10.3760/cma.j.issn.1005-1015.2016.03.006 Copy

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2.	Obana A, Kusumj M, Miki T.Indocyanine green angiographic aspects of multiple evanescent white dot syndrome[J].Retina, 1996, 16(2):97-104.
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7.	Gross NE, Yannuzzi LA, Freund B, et al.Multiple evanescent white dot syndrome[J]. Arch Ophthalmol, 2006, 124(4):493-500.
8.	Marsiqlia M, Gallego-Pinazo R, Cunha de Souza E, et al. Expanded clinical spectrum of multiple evanescent white dot syndrome with multimodal imaging[J]. Retina, 2016, 36(1):64-74. DOI:10.1097/IAE.0000000000000685.
9.	Ikeda N, Ikeda T, Nagata M, et al.Location of lesions in multiple evanescent white dot syndrome and the cause of the hypofluorescent spots observed by indocyanine green angiography[J].Graefe's Arch Clin Exp Ophlhalmol, 2001, 239(3):242-247.
10.	Nguyen NM, Witkin AJ, Reichel E, et al. Microstructural abnormalities in MEWDS demonstrated by ultrahigh resolution optical coherence tomography[J]. Retina, 2007, 27(4):414-418.
11.	Mrejen S, Khan S, Gallego-Pinazo R, et al. Acute zonal occult outer retinopathy:a classification based on multimodal imaging[J]. JAMA Ophthalmol, 2014, 132(9):1089-1098. DOI:10.1001/jamaophthalmol.2014.1683.
12.	Jung JJ, Khan S, Mrejen S, et al. Idiopathic multifocal choroiditis with outer retinal or chorioretinal atrophy[J]. Retina, 2014, 34(7):1439-1450. DOI:10.1097/IAE.0000000000000079.
13.	Montero JA, Ruiz-Moreno JM, Fernandez-Munoz M. Spectral domain optical coherence tomography findings in acute posterior multifocal placoid pigment epitheliopathy[J]. Ocul Immunol Inflamm, 2011, 19(1):48-50. DOI:10.3109/09273948.2010.530733.
14.	Yenerel NM, Kucumen B, Gorgun E, et al. Atypical presentation of multiple evanescent white dot syndrome (MEWDS)[J]. Ocul Immunol Inflamm, 2008, 16(3):113-115.DOI:10.1016/j.ajo.2015.01.015.
15.	Sieving PA, Fishman GA, Jampol LM, et al.Multiple evanescent white dot syndrome, Ⅱ:electrophysiology of the photoreceptors during retinal pigment epithelial disease[J].Arch Ophthalmol, 1984, 102(5):675-679.
16.	Feigl B, Haas A, E1-Shabrawi Y, et al.ERG in multiple evanescent white dot syndrome[J].Graefe's Arch Clin Exp Ophthalmol, 2002, 240(8):615-621.
17.	杨雄里.光感受器和视觉兴奋[M]//杨雄里.视觉的神经机制.上海:科学技术出版社, 1996:87-90.Yang XL. Photoreceptor and visual excitement[M]//Yang XL. Neural mechanisms of vision. Shanghai:Shanghai Sceintific & Technical Publishers, 1996:87-90.
18.	吴乐正.光觉[M]//李凤鸣.中华眼科学.2版.北京:人民卫生出版社, 2005:305-311.Wu LZ. Photesthesis[M]//Li FM.Chinese ophthalmology. 2nd ed. Beijing:People's Medical Publishing House, 2005:305-311.

1. Jampol LM, Sieving PA, Pugh D, et al.Multiple evanescent whitedot syndrome, Ⅰ:clinical findings[J].Arch Ophthalmol, 1984, 102(5):671-674.
2. Obana A, Kusumj M, Miki T.Indocyanine green angiographic aspects of multiple evanescent white dot syndrome[J].Retina, 1996, 16(2):97-104.
3. 周才喜, 刘立民, 毛爱玲, 等.多发性一过性白点综合征的眼底自发荧光观察[J].中华眼科杂志, 2013, 49(12):1089-1093.DOI:10.3760/cma.j.issn.0412-4081.2013.12.007.Zhou CX, Liu LM, Mao AL, et al. The fundus autofluorescence of the multiple evanescent white dot syndrome[J]. Chin J Ophthalmol, 2013, 49(12):1089-1093. DOI:10.3760/cma.j.issn.0412-4081.2013.12.007.
4. Furino C, Boscia F, Cardascia N, et al. Fundus autofluorescence and multiple evanescent white dot syndrome[J]. Retina, 2009, 29(1):60-63.DOI:10.1097/IAE.0b013e31818c5e04.
5. 周金琼, 魏文斌. Optos 200Tx广角眼底血管造影及其临床应用[J].国际眼科纵览, 2015, 39(2):103-106.DOI:10.3760/cma.j.issn.1673-5803.2015.02.007.Zhou JQ, Wei WB. Optos 200TX scanning laser ophthalmoscope for wide-field fluorescein angiography and its clinical application[J]. Int Rev Ophthalmol, 2015, 39(2):103-106. DOI:10.3760/cma.j.issn.1673-5803.2015.02.007.
6. Hideaki H, Shoji K. Ultra-wide-field funds autofluorescence in multiple evanescent white dot syndrome[J]. Am J Ophthalmol, 2015, 159(4):698-706.DOI:10.1016/j.ajo.2015.01.015.
7. Gross NE, Yannuzzi LA, Freund B, et al.Multiple evanescent white dot syndrome[J]. Arch Ophthalmol, 2006, 124(4):493-500.
8. Marsiqlia M, Gallego-Pinazo R, Cunha de Souza E, et al. Expanded clinical spectrum of multiple evanescent white dot syndrome with multimodal imaging[J]. Retina, 2016, 36(1):64-74. DOI:10.1097/IAE.0000000000000685.
9. Ikeda N, Ikeda T, Nagata M, et al.Location of lesions in multiple evanescent white dot syndrome and the cause of the hypofluorescent spots observed by indocyanine green angiography[J].Graefe's Arch Clin Exp Ophlhalmol, 2001, 239(3):242-247.
10. Nguyen NM, Witkin AJ, Reichel E, et al. Microstructural abnormalities in MEWDS demonstrated by ultrahigh resolution optical coherence tomography[J]. Retina, 2007, 27(4):414-418.
11. Mrejen S, Khan S, Gallego-Pinazo R, et al. Acute zonal occult outer retinopathy:a classification based on multimodal imaging[J]. JAMA Ophthalmol, 2014, 132(9):1089-1098. DOI:10.1001/jamaophthalmol.2014.1683.
12. Jung JJ, Khan S, Mrejen S, et al. Idiopathic multifocal choroiditis with outer retinal or chorioretinal atrophy[J]. Retina, 2014, 34(7):1439-1450. DOI:10.1097/IAE.0000000000000079.
13. Montero JA, Ruiz-Moreno JM, Fernandez-Munoz M. Spectral domain optical coherence tomography findings in acute posterior multifocal placoid pigment epitheliopathy[J]. Ocul Immunol Inflamm, 2011, 19(1):48-50. DOI:10.3109/09273948.2010.530733.
14. Yenerel NM, Kucumen B, Gorgun E, et al. Atypical presentation of multiple evanescent white dot syndrome (MEWDS)[J]. Ocul Immunol Inflamm, 2008, 16(3):113-115.DOI:10.1016/j.ajo.2015.01.015.
15. Sieving PA, Fishman GA, Jampol LM, et al.Multiple evanescent white dot syndrome, Ⅱ:electrophysiology of the photoreceptors during retinal pigment epithelial disease[J].Arch Ophthalmol, 1984, 102(5):675-679.
16. Feigl B, Haas A, E1-Shabrawi Y, et al.ERG in multiple evanescent white dot syndrome[J].Graefe's Arch Clin Exp Ophthalmol, 2002, 240(8):615-621.
17. 杨雄里.光感受器和视觉兴奋[M]//杨雄里.视觉的神经机制.上海:科学技术出版社, 1996:87-90.Yang XL. Photoreceptor and visual excitement[M]//Yang XL. Neural mechanisms of vision. Shanghai:Shanghai Sceintific & Technical Publishers, 1996:87-90.
18. 吴乐正.光觉[M]//李凤鸣.中华眼科学.2版.北京:人民卫生出版社, 2005:305-311.Wu LZ. Photesthesis[M]//Li FM.Chinese ophthalmology. 2nd ed. Beijing:People's Medical Publishing House, 2005:305-311.

Chinese Journal of Ocular Fundus Diseases

Imaging features of ultra-wide field fundus autofluorescence in multiple evanescent white dot syndrome

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