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

Su Youn Suh; Jong Ho Park; Seung Min Lee; Sung Who Park; Ji Eun Lee; Ik Soo Byon

doi:10.3341/jkos.2018.59.9.881

Journal List > J Korean Ophthalmol Soc > v.59(9) > 1101027

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Suh, Park, Lee, Park, Lee, and Byon: A Case of Punctate Inner Choroidopathy Followed by Multiple Evanescent White Dot Syndrome

Case Report

J Korean Ophthalmol Soc 2018;59(9):881-886.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.9.881

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

Su Youn Suh, MD¹, Jong Ho Park, MD¹, Seung Min Lee, MD¹, Sung Who Park, MD^2,³, Ji Eun Lee, MD, PhD^2,³, Ik Soo Byon, MD, PhD^1,^3,

¹Research Institute for Convergence of Biomedical Science and Technology, Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea

²Medical Research Institute, Department of Ophthalmology, Pusan National University Hospital, Busan, Korea

³Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea

Address reprint requests to Ik Soo Byon, MD, PhD Department of Ophthalmology, Pusan National University Yangsan Hospital, #20 Geumo-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: 82-55-360-2592, Fax: 82-55-360-2161 E-mail: isbyon@pusan.ac.kr

Received 12 April 2018 Revised 31 May 2018 Accepted 28 August 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Multiple evanescent white dot syndrome, Punctate inner choroidopathy, White dot syndrome

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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.

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.

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.

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