title: FOVEAL EXUDATE AND CHOROIDAL NEOVASCULARIZATION IN ATYPICAL CASES OF MULTIPLE EVANESCENT WHITE DOT SYNDROME.
abstract: OBJECTIVE
  To describe atypical cases of multiple evanescent white dot syndrome (MEWDS) associated with foveal exudation, increased choroidal thickness, and secondary Type 2 (subretinal) neovascularization.
  
  
  METHODS
  Four cases of atypical MEWDS were studied at a retina referral center. Patients underwent evaluation with multimodal retinal imaging, including fluorescein angiography, indocyanine green angiography, spectral-domain and enhanced depth imaging optical coherence tomography (OCT). Two patients were imaged with OCT angiography.
  
  
  RESULTS
  Four patients (3 female, 1 male) with a median age of 23.5 years presented with acute onset, painless, decreased central vision. All cases demonstrated fundus findings consistent with MEWDS on color photography, indocyanine green angiography, fluorescein angiography, fundus autofluorescence, and structural OCT imaging. On structural OCT, all 4 patients were noted to have hyperreflective subretinal material and increased subfoveal choroidal thickness ranging from 307 μm to 515 μm. Type 2 neovascularization was diagnosed in all four patients using fluorescein angiography, indocyanine green angiography, and/or OCT angiography. Two patients had poor visual acuity at the last follow-up despite resolution of characteristic clinical findings of MEWDS.
  
  
  CONCLUSIONS
  A subset of patients with atypical MEWDS may develop persistent poor vision due to subfoveal exudation and secondary Type 2 neovascularization. Patients showing increased choroidal thickness at presentation may be more susceptible to this unusual presentation.
authors.affiliation: *Department of Ophthalmology, New York University Langone Medical Center, New York, New York; †Vitreous Retina Macula Consultants of New York, New York, New York; ‡LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; §Department of Internal Medicine, Metropolitan Hospital Center, New York Medical College, New York, New York; ¶Department of Ophthalmology, University and Polytechnic Hospital La Fe, Valencia, Spain; **Ophthalmic Center for Imaging and Laser, Paris, France; ††Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota; ‡‡Department of Ophthalmology, Mount Sinai Hospital New York, New York; and §§Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia College of Physicians and Surgeons, New York, New York.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chen
authors.forename: Marcela
authors.initials: M
authors.lastname: Marsiglia
authors.forename: Rosa
authors.initials: R
authors.lastname: Dolz-Marco
authors.forename: Sarwar
authors.initials: S
authors.lastname: Zahid
authors.forename: Sarah
authors.initials: S
authors.lastname: Mrejen
authors.forename: Jose S
authors.initials: JS
authors.lastname: Pulido
authors.forename: Salomon Y
authors.initials: SY
authors.lastname: Cohen
authors.forename: Benjamin
authors.initials: B
authors.lastname: Freilich
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Yannuzzi
authors.forename: K Bailey
authors.initials: KB
authors.lastname: Freund
mesh_terms: D000293:Adolescent; D000328:Adult; D020256:Choroidal Neovascularization / Q000175:diagnosis*; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D005500:Follow-Up Studies; D005584:Fovea Centralis / Q000473:pathology*; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D058471:Subretinal Fluid / Q000000981:diagnostic imaging*; D013577:Syndrome; D041623:Tomography, Optical Coherence / Q000379:methods*; D055815:Young Adult