Atypical presentations of multiple evanescent white dot syndrome without white dots: a case series.

PURPOSE: To describe three unusual clinical cases of patients who were diagnosed with multiple evanescent white dot syndrome at the onset of their disease but lacked the characteristic white dots on clinical examination, autofluorescence, and angiographic testing at any time during their follow-up. METHODS: Three eyes of three patients with clinical symptoms of multiple evanescent white dot syndrome seen at an academic clinical practice were included. Retinal imaging, including fluorescein angiography, indocyanine green imaging, fundus autofluorescence, and optical coherence tomography, was used to further characterize and describe the clinical findings. RESULTS: All three patients presented with classic multiple evanescent white dot syndrome complaints. All patients demonstrated classic foveal granularity and mild disk swelling and/or peripapillary whitening. No characteristic hyperfluorescent lesions were seen on fluorescein angiography, and indocyanine green imaging did not demonstrate typical patterns of hypofluorescence and/or leakage. Optical coherence tomography documented focal disruption or loss of the inner segment/outer segment photoreceptor line in all cases. CONCLUSION: Our case series demonstrates another atypical presentation of multiple evanescent white dot syndrome that has not been described previously: foveal involvement at the onset of the disease without white spots.

Morbid complications of otitic hydrocephalus.

PURPOSE: To report two cases of otitic hydrocephalus with long-term complications. DESIGN: Retrospective case reports. PARTICIPANTS: Two patients with otitic hydrocephalus with previously diagnosed otitis media. METHODS: Review of clinical history, radiographic findings, medical and surgical management, and follow-up. RESULTS: Two patients with previously diagnosed otitis media presented with otitic hydrocephalus. Both were found to have elevated opening pressures with lumbar puncture and radiographic evidence of sinus thrombosis. Although the patients received appropriate medical and surgical management, they both suffered long-term complications. Patient 1 is dependent on a ventriculoperitoneal shunt to control headaches and has required multiple shunt revisions. Patient 2 is dependent on a ventriculoperitoneal shunt to control headaches and has permanent decreased visual acuity and bilateral optic neuropathy. During her clinical course, she required an optic nerve sheath fenestration. CONCLUSIONS: Otitic hydrocephalus can result in permanent vision loss and chronic headaches requiring spinal fluid diversion. We report two cases with morbid complications. A collaborative effort from ophthalmologists, otolaryngologists, and neurosurgeons is recommended to achieve the best clinical outcome.