COMPARISON OF FUNDUS AUTOFLUORESCENCE AND INDOCYANINE GREEN ANGIOGRAPHY IN MULTIPLE EVANESCENT WHITE DOT SYNDROME

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2025-02-04 DOI:10.1016/j.xops.2025.100731

Valentine Labattut MD , Yasmine Serrar MD , Armelle Cahuzac MD , Pierre Gascon MD , Martine Mauget-Faÿsse MD , Benjamin Wolff MD , Mariam Ghazaryan MD , Pascal Seve MD, PhD , Laurent Kodjikian MD, PhD , Thibaud Mathis MD, PhD

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Abstract

Purpose

The aim of this study was to compare fundus blue autofluorescence (BAF) images, indicating photoreceptor alteration, and indocyanine green angiography (ICGA), indicating retinal pigment epithelium (RPE) alteration, in multiple evanescent white dot syndrome (MEWDS) to investigate the initial damage location within the RPE-photoreceptor complex.

Design

Multicentric retrospective cohort study carried out across tertiary centers for retinal and inflammatory diseases in France.

Participants

A total of 31 eyes affected by primary MEWDS were included.

Methods

Only primary MEWDS, with sufficiently high-quality images, were included, and their data were analyzed cross-sectionally at baseline and at the recovery phase, between 4 and 8 weeks. A standardized protocol was set up for measuring the areas affected by MEWDS on the late-phase ICGA and on BAF; this was always carried out by the same investigator. On 55° macular-centered images, both the BAF and ICGA areas were delimited and calculated in the FIJI/ImageJ Software and then compared with each other. The same process was used to compare macular areas bounded by a 6-mm diameter Early Treatment Diabetic Retinopathy Study circle centered on the fovea.

Main Outcome Measures

Areas in mm² affected by MEWDS on BAF and ICGA.

Results

The median hypofluorescent area on ICGA (93.03 mm², interquartile range [IQR: 54.08–134.00]) was significantly larger than that affected on BAF (76.22 mm² [IQR: 43.65–122.20], P < 0.0001). The median damaged surface was 37.21% (IQR: 21.63%–53.61%) on ICGA vs. 30.49% (IQR: 17.15%–46.60%) on BAF (P < 0.0001). Regarding only the macular area, damage was also significantly larger on ICGA than in BAF (15.16 [9.55–24.08] mm² vs. 13.48 [4.87–17.82] mm², P < 0.0001).

Conclusions

Our study showed that MEWDS lesions are more extensive in ICGA than in BAF, indicating a predominant RPE dysfunction. We therefore support the hypothesis that MEWDS is a primary retinal pigment epitheliopathy, causing reversible and nondestructive dysfunction of the RPE and photoreceptors. Our results support recent analysis of modern multimodal imaging. Further studies using en face OCT are needed to analyze the outer retinal layers and corroborate the hypothesis.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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眼底自体荧光与吲哚菁绿血管造影在多发性消失性白点综合征中的比较

目的比较多发性消失性白点综合征（MEWDS）患者视网膜色素上皮（RPE）改变的眼底蓝色自身荧光（BAF）图像和吲哚菁绿血管造影（ICGA）图像，探讨RPE-光感受器复合物的初始损伤位置。设计：在法国视网膜和炎症疾病三级中心进行多中心回顾性队列研究。参与者共纳入31只受原发性MEWDS影响的眼睛。方法仅纳入具有足够高质量图像的初级MEWDS，并在基线和恢复阶段（4至8周）对其数据进行横断面分析。制定了一项标准方案，用于在后期ICGA和BAF上测量meds受影响的地区；这总是由同一位调查员进行的。在55°黄斑中心图像上，分别用FIJI/ImageJ软件对BAF和ICGA区域进行划分和计算，并进行比较。同样的方法用于比较以中心凹为中心的直径6毫米的早期治疗糖尿病视网膜病变研究圈为界的黄斑区域。主要结果测量受MEWDS影响的BAF和ICGA面积。结果ICGA的中位低荧光面积（93.03 mm2，四分位数差[IQR: 54.08-134.00]）明显大于BAF的中位低荧光面积（76.22 mm2 [IQR: 43.65-122.20]）， P <；0.0001)。ICGA组损伤面中位数为37.21% (IQR: 21.63% ~ 53.61%)， BAF组为30.49% （IQR: 17.15% ~ 46.60%）。0.0001)。仅黄斑区域，ICGA组的损伤也明显大于BAF组(15.16 [9.55-24.08]mm2 vs. 13.48 [4.87-17.82] mm2, P <；0.0001)。结论我们的研究表明，ICGA的MEWDS病变比BAF更广泛，表明主要的RPE功能障碍。因此，我们支持MEWDS是一种原发性视网膜色素上皮病变的假设，导致RPE和光感受器的可逆和非破坏性功能障碍。我们的结果支持现代多模态成像的最新分析。进一步的研究需要使用正面OCT来分析视网膜外层并证实这一假设。财务披露作者在本文中讨论的任何材料中没有专有或商业利益。

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