A 27-year-old woman with mild myopia presented with blurred vision and photopsia of the right eye for 2 weeks. She had no particular medical or ocular histories.\nThe patient’s best-corrected visual acuity (BCVA) was 1.0 OD (oculus dexter) and 1.5 OS (oculus sinister). Relative afferent pupillary defect was negative. There were no abnormal ocular findings OS. Slit-lamp examination revealed no inflammation in the anterior chamber or vitreous. Funduscopic examination showed multiple, faint, subretinal white dots at the posterior pole to the equator and macular granular change (, arrowheads). In addition, retinal vascular sheathing was observed at the midperiphery (, arrows). Fluorescein angiography (FA) showed hyperfluorescence continuing from the initial phase corresponding to the white dots (, arrowheads) and the staining of the optic disk. The retinal sheathing sites showed vascular staining with leakages in the late-phase OD (, arrows). Indocyanine green angiography showed no abnormal appearance in the initial phase and multiple hypofluorescence at the wider area than the white dots (, arrowheads). Enhanced depth imaging optical coherence tomography (EDI-OCT) revealed the discontinuity of the ellipsoid zone at macular area OD (, arrows) and that the subfoveal choroidal thickness (SCT) was 295 µm. Humphrey perimetry (30-2 Swedish threshold interactive algorithm standard test) showed a mild blind spot enlargement OU (oculus uterque) (mean deviation [MD] value: −1.83 dB OD and −1.08 dB OS). Multifocal electroretinography (mfERG) showed entirely decreased amplitude, except normal central amplitude OD, and mildly decreased amplitude at the retinal site that corresponded to the peripapillary area OS. Infection screening, including tuberculosis, syphilis, human T-cell leukemia virus type 1, and toxoplasmosis, showed negative results on QuantiFERON and serological testing or with antibodies for these agents. The chest X-ray was normal and serum angiotensin-converting enzyme was within normal limit. The patient received a diagnosis of MEWDS OD and was followed up with no treatment. One month after the first visit, the white dots and retinal vascular sheathing spontaneously resolved. After 3 months, the ellipsoid zone at the macula restored and the SCT decreased to 237 µm, together with increased BCVA of 1.5 OD (). On Humphrey perimetry, the MD value improved to −0.28 dB OD and −0.69 dB OS.
The chief complaint for this 29-year-old woman was impaired vision in her left eye. At the initial visit for this this patient, a photograph of her left fundus showed white dots (Figure B) with hyperautofluorescence on FAF (Figure D), while OCT revealed a disrupted or irregular photoreceptor inner outer segment (IS/OS) junction (Figure F) indicated by the arrows. At 1 month after her initial visit, this patient complained of metamorphopsia in her right eye. FP showed that there were white dots in the posterior pole (Figure A), while FAF images obtained using FAF revealed hyperfluorescence in the area surrounding the optic disc (Figure C). OCT showed a disrupted or irregular photoreceptor IS/OS junction in both eyes (Figure E and F) indicated by the arrows. At 4 months after her initial visit, there was almost complete improvement of the metamorphopsia in her right and left eyes. In addition, OCT indicated there was ongoing restoration of the IS/OS line in both eyes (Figure A and B). Although the deviation map of ganglion cell analysis showed there was a decrease of the GCL + IPL thickness in both eyes at her initial visit, her right eye was not affected. During the 4 months of follow-up, the deviation map (Figure C~J) did not indicate any recovery of the decreased GCL + IPL thickness. Signal strengths of all the Cirrus OCT measurements were 10/10.