High Resolution Spectral Domain Optical Coherence Tomography of Multiple Evanescent White Dot Syndrome.

Abstract

To evaluate a patient with multiple evanescent white dot syndrome (MEWDS) with multimodal imaging including high resolution spectral domain optical coherence tomography (SD-OCT). The patient was evaluated with wide-field color and autofluorescence imaging, microperimetry, and near infrared imaging. SD-OCT was performed using an instrument capable of 3 µm axial resolution, the High-Resolution Heidelberg Spectralis. 28 year-old woman developed photopsias and a scotoma in the field of vision of her left eye. She had multiple whitish spots with granularity in her fovea consistent with the diagnosis of MEWDS. She had supportive fluorescein angiographic and autofluorescence findings. Because of the high resolution and the good layer contrast, it was possible to create en face slab images of the external limiting membrane (ELM), the ellipsoid zone (EZ), interdigitation zone (IZ), and the retinal pigment epithelium (RPE). The ELM showed no abnormalities. There were multiple regions of decreased reflectance in the EZ slab, but even more prominent changes in the IZ. The RPE showed nearly no variation in layer reflectivity. With resolution of symptoms, the color and autofluorescence images returned to normal, the defects in the EZ almost completely resolved and the IZ continued to show abnormalities. Although past studies concluded the EZ was the main region of involvement in MEWDS, high resolution SD-OCT suggests the IZ was more prominently affected in this case.