Spectralis High Magnification Module imaging in a case of Multiple Evanescent White Dot Syndrome

Abstract

Purpose: To report the use of Spectralis High Magnification Module (HMM) as part of multimodal imaging in Multiple Evanescent White Dot Syndrome (MEWDS).

Observations: HMM imaging showed a blurry mosaic pattern corresponding to MEWDS-related photoreceptors' lesions. These abnormalities remained detectable at later stages of the disease while other imaging modalities were negative.

Conclusions and importance: HMM can be a useful technique to monitor the structure of the outer retina during the different stages of MEWDS.

Keywords: High magnification module; Imaging; Multiple evanescent white dot syndrome; Photoreceptors; Retina.

Fig. 1

Right eye at baseline; 1.A: Visual Field central 30-2 showing an enlargement of the blind spot; 1.B: hyperautofluorescent dots in the superior and supero-temporal periphery and at the temporal margin of the optic disc; 1.C: Late-phase indocyanine green angiogram showing a sharp hypofluorescent ring around the optic disc and large hypofluorescent retinal areas all around the fovea; 1.D&E: C- and B-scans respectively showing ellipsoid alterations. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

MEWDS-related anomalies seen with HMM and OCT. The area limited by a black line and marked with a red star appears blurry on HMM and may reflect a pathologic photoreceptor mosaic (2.A); its hyporeflectivity on C-scan (2.B) corresponds with an ellipsoid alteration as pointed by the red arrows (2.C). Blue stars indicate unaffected regions with an apparently intact photoreceptor mosaic. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article).

Fig. 3

Evolution of the lesions after 2 months; Left column (baseline) from top to bottom: blue arrows indicating hyporeflective lesions surrounding the fovea corresponding to large areas of ellipsoid alteration on OCT C-scan (3.A) and B-scan (3.B), blurry photoreceptor mosaic on HMM (3.C&D); Right column (2 months later): green arrows showing improvement of the ellipsoid on OCT C-scan (3.E) and B-scan (3.F) with a photoreceptor mosaic returning to normal on HMM (3.G&H). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article).

Fig. 4

At 2 months following presentation, hyperautofluorecent dots disappeared; however, magnification of HMM images allowed to visualize irregularities of the photoreceptor mosaic (red arrows). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article).

Fig. 5

HMM imaging of a healthy eye showing a normal photoreceptor mosaic pattern, magnified in a yellow rectangle. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article).