A 40-year-old Japanese woman presented with a complaint of blurred vision of her left eye for 1 week after catching a cold. Her past medical history was unremarkable. At the initial examination in our hospital, best-corrected visual acuity (BCVA) using a decimal visual test chart was 1.2 and 0.6 in her right and left eyes, while the intraocular pressure (IOP) was 16 and 13 mm Hg in her right and left eyes, respectively. Slit-lamp examination showed there were no inflammatory cells in the anterior chamber and 1+ cells in the vitreous of her left eye. Ophthalmoscopy revealed multiple white dots ranging from the posterior pole to the midperiphery, with yellow granularity observed in the fovea (Fig. ). Fluorescein angiography (FA) revealed the presence of multiple hyperfluorescent spots from the early through the late phase, with staining of the optic disc observed in the late phase (Fig. ). ICGA demonstrated the presence of hypofluorescence in the fovea with multiple hypofluorescent spots ranging from the posterior pole to the midperiphery in the late phase (Fig. ). Hyperfluorescent lesions in FA and hypofluorescent lesions in ICGA demonstrated the presence of multiple white dots in the fundus. A Humphrey field analyzer revealed a slight enlargement of the blind spot of Mariotte in the left eye. SD-OCT demonstrated the presence of a separation between the RPE and Bruch's membrane (BM) (pigment epithelium detachment), discontinuations in the RPE and BM (Fig. ), and a hyper-reflective lesion in the outer retina under the fovea (Fig. ). A loss of the EZ (Fig. ) and a hyper-reflective lesion in the ganglion cell layer (Fig. ) were observed at the parafovea. Choroidal thicknesses at the center of the fovea and the edge of the pigment epithelium detachment were 235 and 250 μm, respectively (Fig. ). Three weeks after the onset, the hyper-reflection spread to the area between the inner lesion of the outer nuclear layer (Fig. ), and an abnormal hyper-reflective lesion appeared within the choroid (Fig. ). In addition, the separation between the RPE and BM was found to have almost completely disappeared (Fig. ). A hyper-reflective band was clearly observed from the RPE to the sclera under the fovea (Fig. ). The patient was diagnosed with MEWDS and treated with prednisolone, with the 15 mg dose gradually tapered after the initial presentation. Four weeks after the onset, several of the white dots disappeared, the yellow granularity in the fovea became slightly smaller, and the BCVA in the left eye improved to 1.2, which was subsequently maintained. OCT showed there was a slight but clear choroidal excavation with a slight separation between the RPE and neural retina detected under the central fovea (Fig. ). Choroidal thicknesses at the center of the fovea and at the edge of the FCE were 183 and 228 μm, respectively (Fig. ). Three months after the onset, the subretinal fluid had been completely absorbed, with the nonconforming FCE then changing to the conforming FCE (Fig. ). BCVA in the left eye was 1.2, a value that was subsequently maintained. The hyper-reflective lesion in the ganglion cell layer completely resolved. Choroidal thicknesses at the center of the fovea and at the edge of the FCE decreased and became 147 and 200 μm, respectively (Fig. ). Six months after the onset, BCVA of the left eye remained at 1.2 and the EZ at the fovea was clearly detected. There has been no subsequent recurrence of MEWDS or choroidal neovascularization observed. The choroidal excavation has gradually deepened (Fig. ), with the choroidal thicknesses at the center of the fovea and at the edge of the FCE determined to be 132 and 191 μm, respectively (Fig. ).
A 46-year-old male patient presented to us with blurring of vision OS since 2 months. His BCVA was 6/6, N6 in OD and 6/12, N8 in OS at presentation. Fundus examination of OS showed an irregular elevated, yellowish-white choroidal lesion with welldefined geographic borders involving the inferior macula with areas of subretinal hemorrhage at and above the fovea suggestive associated choroidal neovascular membrane. SD-OCT showed a dense hyper-reflective choroidal mass with significant widening of the choroidal layers. B-scan ultrasonography revealed high-spike echoes through the lesion suggesting choroidal osteoma. FFA in that area showed staining conforming to the diagnosis of choroidal osteoma with a secondary CNVM. Patient underwent treatment with multiple antiVEGF injections and standard fluence photodynamic therapy (PDT). The patient developed an acquired FCE after 17 months of treatment [].