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How to master MCQs
Published in Chung Nen Chua, Li Wern Voon, Siddhartha Goel, Ophthalmology Fact Fixer, 2017
Multiple evanescent white dot syndrome is often a unilateral condition affecting young female patients. The presentation is usually decreased vision with multiple white dots in the retinal pigment epithelium layer. An enlarged blind spot is common despite a normal optic disc. Vitritis is usually mild. Fluorescein angiography shows early hyperfluorescence of the white lesions. ERG shows a decreased a-wave, suggesting abnormal outer retinal dysfunction. The condition usually resolves spontaneously with good visual recovery.
Posterior uveitis
Published in Gwyn Samuel Williams, Mark Westcott, Carlos Pavesio, Bushra Thajudeen, Practical Uveitis, 2017
Gwyn Samuel Williams, Mark Westcott
This is one condition that is very well known but poorly understood. For a start it is probably much more commonly called multiple effervescent white dot syndrome than multiple evanescent white dot syndrome (MEWDS) mainly I would suspect because people never use the term ‘evanescent’ in daily life and fewer know what it means. Effervescent would imply some kind of fizzy reaction and this is probably why eager eye casualty officers regularly refer cases of MEWDS to the uveitis team when commonly it is APMPPE or MCP present. Another dictum is that an ophthalmologist's first diagnosis of MEWDS is never MEWDS. Evanescent actually means something that quickly fades and disappears, like a snowball in hell perhaps. Patients with MEWDS will almost always be young Caucasian females who present with blur, para-central scotoma and photopsia classically of one eye but again there are exceptions to this, and in which an initial examination of the eye to the untrained might appear normal. Goodness knows in fact how many MEWDS patients have been passed off as having had a posterior vitreous detachment (PVD) in eye casualties around the world. A common alternative wrong diagnosis is retrobulbar neuritis.
Changing Trends in Uveitis in the United Kingdom: 5000 Consecutive Referrals to a Tertiary Referral Centre
Published in Ocular Immunology and Inflammation, 2023
N. P. Jones, S. Pockar, L. R. Steeples
The multiple evanescent white dot syndrome was first described in the USA in 1984,5 and this was gradually followed by worldwide reports. It is clear that this disease was a new entity also associated with a spectrum of manifestations including acute zonal occult outer retinopathy, acute macular neuroretinopathy and acute idiopathic blind spot enlargement. Our first patient was diagnosed in 1997. Over the subsequent 23 years, it is clear that MEWDS and associated conditions are substantially increasing in frequency. We have been unable to find any previous reference to the changing incidence of MEWDS worldwide, but a population-based estimate in Minnesota over the period 1988–201816 was 0.22 (0.04–0.39)/100 000 per annum (pa). In this clinic, using the GM population as an approximate indicator, the incidence has risen from 0.03 to 1.3/100 000 pa. The aetiology remains unknown.
Expanding the Clinical Spectrum of Multiple Evanescent White Dot Syndrome with Overlapping Multifocal Choroiditis
Published in Ocular Immunology and Inflammation, 2022
Hyun Goo Kang, Tae Young Kim, Min Kim, Suk Ho Byeon, Sung Soo Kim, Hyoung Jun Koh, Sung Chul Lee, Christopher Seungkyu Lee
Multiple evanescent white dot syndrome (MEWDS) was first described in 1984 as an acute, idiopathic, unilateral retinopathy that occurs predominantly in young and otherwise healthy women, with spontaneous improvement in visual symptoms and resolution of all characteristic lesions over several weeks.1 The clinical features are well documented; however, the precise pathogenesis remains unknown because of conflicting interpretations of the results from multimodal imaging.,2,3 Whether MEWDS is caused by an immune-mediated mechanism and/or genetic susceptibility is not certain.4 Furthermore, the primary target of inflammation is also in debate, with arguments for it as a disease primarily of the photoreceptors5 or at the benign end of the disease spectrum described as primary inflammatory choriocapillaropathies.6
Reply To: “Zicarelli F Et al. Multimodal Imaging of Multiple Evanescent White Dot Syndrome: A New Interpretation”
Published in Ocular Immunology and Inflammation, 2021
We have read with an utmost interest the Manuscript by Dr. Zicarelli et al.1 entitled “Multimodal Imaging of Multiple Evanescent White Dot Syndrome: A New Interpretation” which analyzes the different hypotheses that could explain the signs of MEWDS based on multimodal imaging. The authors have concluded that “the photoreceptors alterations may be consequent to RPE dysfunction.” We can only agree with this conclusion. Indeed, through a different reasoning, we have drawn the same conclusion.2 In our analysis, we have taken into account the experimental work by Chang A et al.3, who have shown that ICG enters progressively the RPE cells in a human eye and is clearly visible forty minutes after venous dye injection. These findings have been confirmed in monkey eyes. Several experiments have also shown ICG uptake by RPE cells in vitro.4,5 It is assumed that ICG is incorporated into RPE cells via a Na+ cotransporter and retained in the cytoplasm, although the in vitro studies have not specifically investigated the entry of ICG into RPE cells at their basal side.4 We have then hypothesized that the lack of ICG internalization by the RPE could be responsible for the dark appearance of MEWDS dots on late-stage ICGA. Like Dr Zicarelli et al.1, we have concluded that MEWDS was a reversible nondestructive RPE dysfunction resulting in a temporary impairment of the photoreceptors. The authors should be acknowledged to have added new evidence to this hypothesis.