Abstract
Purpose To investigate relationships between total thickness and the thickness of inner and outer layers in the choroid during regression in patients with multiple evanescent white dot syndrome (MEWDS). Methods This retrospective observational case series included 15 unilaterally affected eyes and 13 unaffected fellow eyes from 15 MEWDS patients (4 men and 11 women; mean age, 37.6 ± 17.6 years). Using enhanced depth imaging optical coherence tomography, whole, inner, and outer choroidal layer thicknesses at the fovea and perifovea were manually measured at the initial visit and at 1 and 3 months after the initial visit. The mean thickness values of the layers were compared at each stage. Results With regression of MEWDS, the mean subfoveal whole and inner choroidal layer thicknesses significantly decreased at 1 and 3 months compared to baseline values in MEWDS eyes (P=0.01 and P < 0.0001, respectively), but not in fellow eyes. The outer layer in MEWDS eyes tended to thin. Changes in the inner and outer layers at the perifovea in MEWDS eyes also showed the same trends. Simple linear regression analysis revealed significant positive correlations in choroidal thickness changes between the whole and inner layers (R = 0.53, P=0.04) and between the whole and outer layers (R = 0.91, P < 0.0001) from baseline to 3 months. Multiple linear regression analysis revealed that choroidal thickness changes in the whole layer were significantly correlated with those in the inner (β = 0.51, P < 0.0001) and outer (β = 0.73, P < 0.0001) layers. Conclusion The inner choroidal layer significantly thinned with regression of MEWDS, correlating with the thinning of total choroidal thickness. These results suggest that MEWDS lesions in the choroid are likely to lie mainly in the inner layer.
Highlights
Multiple evanescent white dot syndrome (MEWDS) is an inflammatory chorioretinal disease associated with transient subretinal white dots
Multiple hypofluorescent spots observed in MEWDS on indocyanine green angiography (ICGA) suggested choriocapillaris hypoperfusion [7]
All patients had unilateral involvement at the initial visit, and no unaffected fellow eye developed signs of acute zonal occult outer retinopathy during follow-up. e mean refractive error was −5.5 ± 3.8 D ranging from +1.5 D to −12.0 D in MEWDS eyes and −5.4 ± 3.5 D ranging from +1.0 D to −11.0 D in unaffected fellow eyes. ere was no significant difference in refractive error between the two groups (P 0.91)
Summary
Multiple evanescent white dot syndrome (MEWDS) is an inflammatory chorioretinal disease associated with transient subretinal white dots. In eyes with MEWDS, optical coherence tomography (OCT) shows macular photoreceptor impairment, which is associated with visual function of MEWDS [1]. Hyperautofluorescence observed on fundus autofluorescence corresponding to the acute MEWDS lesions reveals the presence of retinal pigment epithelium lesions in this disease [2]. Recent observations on OCT angiography in MEWDS showed contradictory results (reduced or preserved flow void at the choriocapillaris) [3,4,5,6]. Ese results may indicate that the presence of circulation disorder at the level of choriocapillaris has yet to be determined in MEWDS. Multiple hypofluorescent spots observed in MEWDS on indocyanine green angiography (ICGA) suggested choriocapillaris hypoperfusion [7]. During the regression of MEWDS, macular choroidal thickness significantly decreased and choroidal blood flow
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