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.