Multiple evanescent white dot syndrome (MEWDS) following inactivated COVID-19 vaccination (Sinovac-CoronaVac)

Abstract

A 38-year-old woman presented with photopsias and progressive but painless loss of vision in her right eye. Of note, she had received the first dose of inactivated COVID-19 vaccine (Sinovac/China National Pharmaceutical Group) 2 weeks prior to the onset of symptoms. Ophthalmic evaluation revealed a wreath-like foveal pattern and multiple gray-white dots throughout the posterior pole associated with discrete vitreous inflammatory reaction. Multimodal imaging analysis confirmed a diagnosis of multiple evanescent white dot syndrome. The patient underwent treatment with corticosteroids and, over the following weeks, her visual acuity improved to standard pattern.

Figure 1

Baseline multimodal imaging analysis of the right eye. (A) The multicolor fundus image shows altered macular reflex and retinal pigment epithelium atrophy with multiple gray-white dots at the macula and midperiphery (white arrows). (B) Fundus autofluorescence indicates widespread multiple hyperautofluorescent lesions in the outer retina (yellow arrows). (C) Spectral domain optical coherence tomography reveals a fragmented ellipsoid zone and irregular reflectivity of the retinal external limiting membrane at the center of the fovea (yellow arrowhead). (D and E) Widefield fluorescein angiography shows hyperfluorescent dots spread throughout the retina during the venous (D) and arteriovenous (E) phases, as well as leakage at the nasal section of the optic nerve.

Figure 2

Multimodal imaging analysis of the right eye during follow-up. (A) The fundus image of the right eye shows partial regression of the white lesions and foveal changes. (B) Spectral domain optical coherence tomography of the right eye shows improvement of ellipsoid zone reflectivity (white arrow). (C and D) Fluorescein angiography shows persistence of the hyperfluorescent dots (yellow arrows) with decreased leakage at the nasal section of the optic nerve.