J Korean Ophthalmol Soc.  2015 Aug;56(8):1289-1293. 10.3341/jkos.2015.56.8.1289.

Multiple Evanescent White-Dot Syndrome in a 14-Year-Old Girl

• Kim SY
• Han KJ
• Jin SY
• Lee YH
• Chang YS

• KMID: 2215085
• DOI: http://doi.org/10.3341/jkos.2015.56.8.1289

Abstract

PURPOSE
To report a case of multiple evanescent white-dot syndrome (MEWDS) in a 14-year-old female.
CASE SUMMARY
A 14-year-old female presented with decreased visual acuity. Review of systems was unremarkable except for a recent upper respiratory infection prior to her symptoms. On examination, her visual acuity was 20/20 in the right eye and 20/200 in the left eye. Relative afferent pupillary defect was observed. Examination of the left fundus revealed optic disc edema and multiple white dots in the posterior pole. Humphrey visual field test showed enlargement of the blind spot in the left eye. Fluorescein angiography revealed hyperfluorescence and late leakage of the white dots. Indocyanine green angiography showed enlarged late hypofluorescence of the white dots. MEWDS was diagnosed and the patient was followed up with serial examinations. At a follow-up examination 2 weeks later, visual acuity in the left eye improved to 20/70. The majority of white dots on fundus had disappeared and the enlarged scotoma in the left eye recovered to normal size on Humphrey visual field test. At a follow-up examination 3 months later, visual acuity in the left eye improved to 20/30 and residual white dots had further disappeared.
CONCLUSIONS
Cases of MEWDS have been reported in patients as old as 67 years; however, MEWDS is a rare disease and most patients are young females. The authors describe the youngest case to date in Korea of MEWDS in 14-year-old female with typical clinical course.

Keyword

Multiple evanescent white-dot syndrome

MeSH Terms

Adolescent*
Angiography
Edema
Female*
Fluorescein Angiography
Follow-Up Studies
Humans
Indocyanine Green
Korea
Optic Disk
Pupil Disorders
Rare Diseases
Scotoma
Visual Acuity
Visual Field Tests
Indocyanine Green

Figure

• 

  Figure 1. (A, B) Fundus photographs obtained at the first visit when her best corrected visual acuity was 20/200. (B) Multiple white dots at the posterior pole in her left eye. (C, D) Fluoresein angiography showing multiple hyperfluorescent spots in the early and late phase. (E, F) Indocyanin green angiography showing multiple hyperfluorescent spots in the early phase. Indocyanin green an-giography showing enlarged hypofluorescent spots in the late phase. (G) OCT image demonstrating the focal defect at the junction of the inner and outer segment of photoreceptor cell (IS/OS). (H) Humphrey visual field (graytone diplay) showing enlargement of the physiologic blind spot. OCT = optical coherence tomography.

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  Figure 2. After 2 weeks, her best corrected visual acuity improved to 20/70. (A) Some multiple white dots disappeared. (B) Enlarged scotoma recovered to normal size.

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  Figure 3. After 3 months, her best corrected visual acuity improved to 20/30. (A) Multiple white dots disappeared and (B) scotoma size slightly increased, but she had no symptom.

Reference

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