Involvement of Inner Choroidal Layer in Choroidal Thinning during Regression of Multiple Evanescent White Dot Syndrome

Figure 1

Images of the left eye in a patient with multiple evanescent white dot syndrome (MEWDS). (a) Funduscopic photograph showing multiple subretinal white dots extending from the posterior pole to the midperiphery and foveal granularity at the initial visit. (b) Late-phase indocyanine green angiograpahy (ICGA) showing numerous hypofluorescent spots scattered more broadly than white dots. An arrowhead indicates the closest hypofluorescent spot from the fovea where choroidal thickness was measured, as shown in Figure 1(d). (c) Three months after the initial visit, the white dots spontaneously resolved. (d–f) Horizontal enhanced depth imaging optical coherence tomography images through the fovea. The outer choroidal layer thicknesses (blue lines) were measured from the inner border of the choroid-sclera junction to the innermost points of large choroidal vessels (asterisks) observed in closest proximity to the subfovea and the perifovea (identical with an arrowhead of Figure 1(b)). The inner choroidal layer thicknesses (red lines) were obtained via subtraction of the outer layers (blue lines) from the whole thicknesses (yellow lines). Diffuse loss of the ellipsoid zone at the macular area was observed at the initial visit, with subfoveal and perifoveal lesions (Fig. 1(b); yellow arrowhead) thickness values of 146, 237, and 384 µm and 111, 264, and 375 µm for the inner, outer, and whole layers, respectively (d). One month after the initial visit, the macular ellipsoid zone improved. Thickness values at the subfoveal and perifoveal lesion sites decreased to 133, 225, and 359 µm and 99, 243, and 342 µm in the inner, outer, and whole layers, respectively (e). Three months after the initial visit, thickness values at these lesions further decreased to 122, 207, and 330 µm and 95, 235, and 330 µm in the inner, outer, and whole layers, respectively, with spontaneous complete recovery of the macular ellipsoid zone (f).

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