J Korean Ophthalmol Soc.  2018 Sep;59(9):881-886. 10.3341/jkos.2018.59.9.881.

A Case of Punctate Inner Choroidopathy Followed by Multiple Evanescent White Dot Syndrome

• Suh SY
• Park JH
• Lee SM
• Park SW
• Lee JE
• Byon IS

• KMID: 2420339
• DOI: http://doi.org/10.3341/jkos.2018.59.9.881

Abstract

PURPOSE
To report a delayed onset of multiple evanescent white dot syndrome in a patient with punctate inner choroidopathy.
CASE SUMMARY
A 23-year-old female complained about sudden visual loss in the right eye. Best-corrected visual acuity (BCVA) was 20/100 in the right eye and 20/20 in the left eye. In fundus examination and optical coherence tomographic images, subfoveal choroidal neovascularization (CNV) with hemorrhage was observed in the right eye, accompanied by multiple lesions of atrophic pigmentation on the posterior pole in both eyes. We diagnosed the patient as punctate inner choroidopathy (PIC) and CNV in the right eye, and treated her using three monthly intravitreal injections of bevacizumab (Avastin®, Roche, Basel, Switzerland; 1.25 mg/0.05 mL). The CNV regressed and the BCVA improved to 20/20. Two years later, she complained of visual impairment in her left eye. The BCVA was 20/40. Fundus photography revealed numerous small white dots around the posterior pole and optic disc. Disruption of the photoreceptor layer was seen in optical coherence tomography images. Small white dots were observed as multiple hyperfluorescent dots in fluorescein angiography and hypofluorescent spots in indocyanine green angiography. An enlarged blind spot was observed in the visual field. We diagnosed her as multiple evanescent white dot syndrome (MEWDS). One month after systemic steroid treatment, the multiple white dots disappeared and the BCVA improved to 20/20.
CONCLUSIONS
We determined that PIC and MEWDS, which belong to the white dot syndrome, could occur in a patient at different times.

Keyword

Multiple evanescent white dot syndrome; Punctate inner choroidopathy; White dot syndrome

MeSH Terms

Angiography
Bevacizumab
Choroidal Neovascularization
Female
Fluorescein Angiography
Hemorrhage
Humans
Indocyanine Green
Intravitreal Injections
Optic Disk
Photography
Pigmentation
Switzerland
Tomography, Optical Coherence
Vision Disorders
Visual Acuity
Visual Fields
Young Adult
Bevacizumab
Indocyanine Green

Figure

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  Figure 1. Multimodal images at the initial visit. (A) Fundus photograph shows multiple atrophic lesions in both eyes and choroidal neovascularization (CNV) with subretinal hemorrhage in right eye. (B) Multiple hyperfluorescent lesions due to increased transmission of both eyes and leakage from CNV of the right eye are observed in fluorescein angiography. (C) Indocyanine green angiography demonstrates multiple hypofluorescent dots. (D) Optical coherence tomography of the right eye shows subfoveal CNV.

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  Figure 2. Multimodal images 2 years later. (A) In the fundus examination, numerous whitish dots are around the posterior pole and optic disk in the left eye. (B) Early and late phase fluorescein angiographies show persistent multiple hyperfluorescent spots. (C) Indocyanine green angiography demonstrates hypofluorescent spots in the left eye. More hypofluorescent spots are observed in the late phase than in the early phase. (D) Disruption of photoreceptor layers of the left eye is detected in the optical coherence tomography. (E) Enlarged blind spot and central scotoma are detected in the automated visual field test.

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  Figure 3. Multimodal images of the left eye after recovery of multiple evanescent white dot syndrome. (A) Fundus photograph shows disappearance of whitish dots and previous atrophic lesions resulting from punctate inner choroidopathy. (B) Size of blind spot and central scotoma recover. (C) Optical coherence tomography shows intact photoreceptor layers.

Reference

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