Neovessel as first manifestation of relapse of associated multifocal choroiditis and MEWDS

Eduardo Morizot,Camila Schiavo Froner

doi:10.1186/s40942-019-0175-x

Abstract

PurposeTo 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.MethodsRetrospective case report and literature review. The clinical findings were documented by fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography (OCT-A).ResultsThe 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.ConclusionThis 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.

Highlights

Multifocal choroiditis (MC) is part of a spectrum of inflammatory diseases known as White Dot Syndrome
We find the multiple evanescent white dot syndrome (MEWDS), which affects mostly young myopic women, associated with photopsias and central or paracentral scotoma
This study aims to report a case of multifocal choroiditis that has relapsed as choroidal neovascularization in the contralateral eye followed by a mixed aspect of MEWDS and MC

Summary

Introduction

Multifocal choroiditis (MC) is part of a spectrum of inflammatory diseases known as White Dot Syndrome. MC is characterized by yellowish-white lesions that might affect the posterior pole and mid-periphery and is more common in women [1–3]. In 23–25% of affected eyes, it develops into choroidal neovascularization [4]. Within this spectrum, we find the multiple evanescent white dot syndrome (MEWDS), which affects mostly young myopic women, associated with photopsias and central or paracentral scotoma. Fluorescein angiography shows hyperfluorescent spots that generally converge circularly, with a discrete staining in the late phases of the exam. The granular shaped stain practically confirms the diagnosis. These changes decrease within weeks or months, with a good prognosis for the

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