Acquired focal choroidal excavation associated with multiple evanescent white dot syndrome: observations at onset and a pathogenic hypothesis
Using indocyanine green angiography we examined two patients with multiple evanescent white-dot syndrome. Both patients had unilateral loss of vision and a fundus appearance typical of multiple evanescent white-dot syndrome. Fluorescein angiography in both patients disclosed a patchy hyperfluorescent pattern at the level of the retinal pigment epithelium. Using indocyanine green angiography, we observed multiple deep, small, round hypofluorescent lesions that appeared early and persisted into the late phases. The spots appeared to block the underlying choroidal pattern. These hypofluorescent spots were clearly visible and present throughout the posterior pole. Many more spots were seen on indocyanine green angiography than were visible by clinical examination or angiography. After follow-up examinations, there was a rapid resolution of the spots over four to six weeks with return of vision. Our findings show that indocyanine green angiography can be a valuable tool in the recognition and further understanding of multiple evanescent white-dot syndrome.