WHY THE DOTS ARE BLACK ONLY IN THE LATE PHASE OF THE INDOCYANINE GREEN ANGIOGRAPHY IN MULTIPLE EVANESCENT WHITE DOT SYNDROME.
OBJECTIVE
To determine what retinal layer is primarily involved in multiple evanescent white dot syndrome compared with acute posterior multifocal placoid pigment epitheliopathy using multimodal imaging including indocyanine green angiography.


METHODS
Color fundus photographs and fluorescein angiography, ICGA and spectral domain optical coherence tomography images of two typical acute cases, one of acute posterior multifocal placoid pigment epitheliopathy and one of multiple evanescent white dot syndrome, were assessed and compared.


RESULTS
In both diseases, white plaques or dots were seen at the posterior pole. The hypofluorescence of acute posterior multifocal placoid pigment epitheliopathy in the early phase of the fluorescein angiography and throughout the ICGA sequence suggested a multifocal choroidal hypoperfusion as the cause of the opacification of the outer retina corresponding to its hyper-reflectivity on spectral domain optical coherence tomography. In multiple evanescent white dot syndrome, there was no choroidal filling defect and the white spots were silent in the early phase of the ICGA, whereas they became black only in the late phase. The outer retina was also altered at the spots.


CONCLUSIONS
In multiple evanescent white dot syndrome, the late hypofluorescence of the white spots on ICGA was likely due to the absence of ICG uptake by a damaged retinal pigment epithelium. Multiple evanescent white dot syndrome seems as a primary reversible nondestructive retinal pigment epitheliopathy, whereas acute posterior multifocal placoid pigment epitheliopathy is a true choroidopathy.
*Service d'Ophtalmologie, AP-HP, Hôpital Lariboisière, Université Paris Diderot, Paris, France; and †Quinze-Vingts Hospital Departement Hospitalo-Universitaire SightMaintain, Institut National de la Recherche Medicale (INSERM)-Direction de l'Hospitalisation et de l'Organisation des Soins CIC, Paris, France.
Alain
A
Gaudric
Sarah
S
Mrejen
D000328:Adult; D005451:Fluorescein Angiography / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green / Q000378:metabolism; D008297:Male; D012164:Retinal Diseases / Q000473:pathology*; D055213:Retinal Pigment Epithelium / Q000473:pathology
D007208:Indocyanine Green