A 16-year-old woman with mild myopia complained of blurred vision and photopsia of the right eye for 1 month. The patient had no particular medical or ocular histories.\nHer BCVA was 1.2 OU. Relative afferent pupillary defect was negative. Left eye was normal. Slit-lamp examination revealed no cells in the anterior chamber, but mild anterior vitreous cells OD. Funduscopic examination showed multiple, faint, small, subretinal white dots at the posterior pole to the midperiphery (, arrowheads), macular granularity, and retinal vascular sheathing at superotemporal midperiphery (, arrows). On FA, the hyperfluorescence was seen from the initial phase corresponding to the white dots (, arrowhead), with the staining of the optic disk and vascular leakages corresponding to the retinal vascular sheathing on the late phase (, arrow). On late-phase indocyanine green angiography, multiple spots of hypofluorescence were observed at the wider area despite no initial abnormal findings (, arrowheads). EDI-OCT revealed segmental loss of the ellipsoid zone at areas of the white dots (, arrows), and the SCT was 341 µm. Goldmann perimetry showed a mild blind spot enlargement of 5×10 degree OD and no abnormality OS. On Humphrey perimetry, MD value was −5.47 dB OD, and OS was unmeasured. In mfERG, entirely decreased amplitude except central normal amplitude was present OD, and the result was normal OS. Systemic screening, similar to what was done for Case 1, showed negative results. She was diagnosed as having MEWDS OD and was followed up with no treatment. One month later, white dots and retinal vasculitis spontaneously disappeared. Three months after the initial visit, the ellipsoid zone at the macula restored and the SCT decreased to 319 µm (). The BCVA remained unchanged. Twelve months after the initial visit, the MD value improved to −0.24 dB OD. Thereafter, there were no recurrences of MEWDS during follow up.
A 54-year-old Japanese woman presented with bilateral blurring of vision associated with headache that had started 2 weeks earlier. Her general family medical history and her personal medical history, including her history of ocular disease, were unremarkable. The best-corrected visual acuity on presentation was 0.6 in the right eye and 0.1 in the left eye. The intraocular pressure was normal in both eyes. Slit-lamp biomicroscopy showed bilateral anterior chamber cells and posterior synechiae, and fundus examination showed bilateral disc swelling with exudative retinal detachment (fig. ).\nFluorescein angiography detected bilateral multifocal leakage with pooling of dye in the subretinal space in the late phase (fig. ). Indocyanine green angiography showed patches of hyperfluorescence and hypofluorescent spots bilaterally (fig. ). A spectral-domain OCT (Cirrus HD-OCT 4000; Carl Zeiss Meditec Inc.) image of the eyes showed the bilateral presence of subretinal fluid and pigment epithelial detachment. Moreover, only in the left eye was unilateral choroidal excavation detected under the fovea, and the contour of the retinal pigment epithelium appeared to be conforming to the shape of the fibrin (fig. ).\nSystemic workup revealed positive HLA-DR4 as well as cerebrospinal fluid pleocytosis. A diagnosis of VKH was reached soon afterwards. Thus, our patient was treated with intravenous pulse methylprednisolone followed by oral prednisolone (initial dose of 40 mg/day) with tapering over a course of 6 months. Treatment successfully resolved the VKH symptoms, and serial OCT showed a gradual reduction in size and a subsequent disappearance of the subretinal fibrin and fluid (fig. ). However, 1 month after having started treatment, the eye was left with an area of choroidal excavation at the fovea despite a normal contour in the right eye (fig. ). There was a good recovery of visual acuity, with 1.2 and 0.9 in the right and the left eye, respectively. Presently, the patient is being followed-up without complications and medications.