A Simple New Technique to Peel Epiretinal Membrane Without Removing Silicone Oil.

PURPOSE: To introduce a new surgical technique that can keep constant intraocular pressure of the eyeball during peeling epiretinal membrane under silicone oil status. METHODS: A viscoelastic agent was injected into the air pump of the constellation system via the metal tip. This procedure offers a buffer zone to keep constant pressure within the eyeball without disturbing the surgical field by an air bubble. RESULTS: Three cases were performed efficiently (15 ± 5 minutes) under this technique with improvement in anatomical feature and visual function after the surgery. CONCLUSION: Using this simple yet important technique can provide us the constant intraocular pressure without hypotony and avoid the traditional complicated procedures.

Retinal astrocytoma with exudative retinal detachment treated with photodynamic therapy in a young girl with tuberous sclerosis.

Around 50% of patients with tuberous sclerosis have the manifestation of retinal astrocytomas. Symptomatic retinal astrocytomas are very rare, with no consensus on optimal treatment. A 7-year-old patient with tuberous sclerosis presented with progressive blurred vision in the right eye for more than half a year. On examination, best-corrected visual acuity was 20/30 in the right eye and 20/20 in the left eye. Dilated fundus examination of the right eye showed a well-circumscribed, elevated, opaque lesion, with surrounding lipid exudate, and retinal detachment involving the fovea. Spectral-domain optical coherence tomography of the right eye revealed an intraretinal lesion with adjacent subretinal fluid. A diagnosis of retinal astrocytoma with exudative retinal detachment was made. The patient was treated with verteporfin photodynamic therapy (PDT) on the lesion in the right eye. After 1 month, complete resolution of subretinal fluid was observed. At 21-month follow-up, the right eye vision was stable at 20/20, without ocular or systemic adverse events. In conclusion, PDT had a good safety profile in a cooperative pediatric patient, and was able to induce regression of astrocytoma as well as resolution of exudation with excellent visual outcome.

Acute macular edema and peripapillary soft exudate after pancreas transplantation with accelerated progression of diabetic retinopathy.

BACKGROUND: The effect of pancreas transplantation on diabetic retinopathy remains inconclusive. Herein, we report six patients with type 1 diabetes mellitus (DM) who underwent pancreas transplantation and developed acute macular edema and peripapillary soft exudate with rapid progression to proliferative diabetic retinopathy. METHODS: In this retrospective observational study, diabetic patients who underwent pancreas transplantation in a single medical center and developed symptomatic acute macular edema and peripapillary soft exudate within 3 months after the operation were enrolled. The complete ophthalmic course and medical records of the patients were retrospectively reviewed. Diabetic retinopathy and progression following treatment after pancreas transplantation were measured. RESULTS: Six Chinese women with type 1 DM were enrolled in this study. Mean hemoglobin (Hb) A1c was 13.4% prior to transplantation and decreased rapidly to 6.5% within 2 months postsurgery. The patients had no or mild pretransplant diabetic retinopathy and developed acute symptomatic macular edema and peripapillary soft exudate in both eyes after pancreas transplantation. All macular edema resolved either with or without treatment. Five cases progressed to proliferative diabetic retinopathy and received panretinal photocoagulation. Diabetic retinopathy remained stable in all eyes after treatment, and the visual prognosis was good, except in one eye that had macular branch retinal artery occlusion with foveal involvement. CONCLUSION: Acute macular edema after pancreas transplantation has a favorable treatment outcome despite rapid progression to proliferative diabetic retinopathy. High pretransplant HbA1c and abrupt blood sugar normalization may be related to the disease course.

Focal Nonperfusion of Deep Retinal Capillary Plexus in Eyes With Epiretinal Membranes Revealed by Optical Coherence Tomography Angiography.

BACKGROUND AND OBJECTIVE: To evaluate the leakage pattern in eyes with idiopathic epiretinal membranes (ERM) using fluorescein angiography (FA) and the structure of the retinal capillary plexus with optical coherence tomography angiography (OCTA). PATIENTS AND METHODS: The authors enrolled patients with idiopathic macular ERM in the consecutive case series study. All patients were evaluated using FA at the central macula area and OCTA at the central 3 mm × 3 mm. RESULTS: Six patients (seven eyes) with ERM completed this preliminary study. The authors examined five eyes that showed increased macular thickness without a lamellar hole and two eyes that showed combined ERM with a lamellar hole. In the five eyes with ERM alone, the irregular focal hypofluorescent areas in FA corresponded to the locations of absent or low flow signals within vasculatures in the deep retinal capillary plexus seen in OCTA, whereas most of the superficial retinal capillary plexus was not affected, except vascular tortuosity in OCTA. In the two eyes combined with lamellar hole, OCTA showed central cystic lesions without vasculatures, but no low flow signals within vasculatures in the deep retinal capillary plexus beyond the hole. These focal irregular, absent, or low flow signals within vasculatures in the deep retinal plexus improved 1 month after surgical removal of the ERM in one eye. CONCLUSION: Mechanical stress exerted from the ERM might affect deep retinal capillary flow more profoundly than the superficial capillary flow, which would account for the fluorescence changes seen in FA. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:404-409.].

Visual prognosis of massive submacular hemorrhage in polypoidal choroidal vasculopathy with or without combination treatment.

BACKGROUND: Submacular hemorrhage associated with polypoidal choroidal vasculopathy (PCV) may cause severe visual loss. The purpose of this study is to report the visual prognosis of massive submacular hemorrhage in patients with PCV. METHODS: Twenty patients with PCV and submacular hemorrhage who received either subretinal tissue plasminogen activator (TPA) with vitrectomy or intravitreal injection of TPA and gas to achieve pneumatic displacement of the hemorrhage were enrolled. Additionally, combination treatment with either photodynamic therapy (PDT) or intravitreal injection of vascular endothelial growth factor inhibitors (anti-VEGF) was performed to treat the underlying PCV. RESULTS: Five patients received subretinal TPA with vitrectomy and 15 patients received intravitreal injection of TPA and gas to remove or displace the submacular hemorrhage. Combination treatment with PDT and intravitreal anti-VEGF was performed in three patients and intravitreal anti-VEGF injection alone in 13 patients. The mean logarithm of the minimal angle of resolution converted from the best corrected visual acuity (BCVA) were improved at 3 months, 6 months, and 12 months. Better initial BCVA, smaller size of submacular hemorrhage and younger age were statistically significant predictors for BCVA. Combination treatment with PDT showed significant efficacy in the improvement of BCVA. CONCLUSION: Combination treatment of submacular hemorrhage secondary to PCV may yield visual and anatomic improvements. Initial BCVA, the initial size of submacular hemorrhage and age were significant predictors for visual prognosis.

Needle decompression in a patient with vision-threatening orbital emphysema.

Orbital emphysema is a condition resulting from trapping of air in loose subcutaneous or orbital tissues from the paranasal sinuses. This condition commonly seen in patients with a history of periorbital trauma or surgery, especially following sneezing or nose blowing. It usually has a benign and self-limited course. However, the entrapped orbital air can cause a substantial increase in pressure with restricted ocular motility or vascular compromise and become severe enough to cause visual impairment. We herein present the case of a patient who developed severe orbital emphysema after blunt trauma followed by sneezing and was successfully treated with needle decompression of intraorbital air. Emergency needle decompression resulted in an improvement in vision and intraocular pressure.

The REVEAL Study: Ranibizumab Monotherapy or Combined with Laser versus Laser Monotherapy in Asian Patients with Diabetic Macular Edema.

OBJECTIVE: The primary study hypothesis was that ranibizumab 0.5 mg monotherapy or combined with laser is superior to laser monotherapy based on mean average change in best-corrected visual acuity (BCVA) over 12 months in Asian patients with visual impairment resulting from diabetic macular edema (DME). DESIGN: A 12-month, randomized, double-masked, multicenter, laser-controlled, phase III study. PARTICIPANTS: Three hundred ninety-six patients aged ≥18 years, with type 1 or 2 diabetes mellitus, BCVA of 78-39 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, and visual impairment resulting from DME. METHODS: Patients were randomized to ranibizumab + sham laser (n = 133), ranibizumab + active laser (n = 132), or sham injection + active laser (n = 131). Ranibizumab/sham injections were administered on day 1 and continued monthly. As of month 3, monthly injections were continued if stable vision was not reached. Treatment was reinitiated if BCVA decreased because of DME progression. Active/sham laser was administered on day 1 and thereafter according to ETDRS guidelines. MAIN OUTCOME MEASURES: Average change in BCVA from baseline to months 1 through 12, central retinal subfield thickness (CRST), and safety over 12 months. RESULTS: Ranibizumab monotherapy or combined with laser was superior to laser in improving mean average change in BCVA from baseline to months 1 through 12 (+5.9 and +5.7 vs +1.4 letters). At month 12, greater proportion of patients gained ≥15 letters with ranibizumab and ranibizumab + laser compared with laser (18.8% and 17.8% vs 7.8%). Mean CRST reduced significantly from baseline to month 12 with ranibizumab (-134.6 µm) and ranibizumab + laser (-171.8 µm) versus laser (-57.2 µm). Patients received a mean of 7.8 and 7.0 ranibizumab injections in the ranibizumab and ranibizumab + laser arms, respectively, and 1.5-1.9 active laser across treatment arms over 12 months. Conjunctival hemorrhage was the most common ocular, whereas nasopharyngitis and hypertension were the most common nonocular adverse events. Ranibizumab was not associated with any cases of cerebrovascular hemorrhage and cerebrovascular ischemia. No death related to study treatment was reported. CONCLUSIONS: Ranibizumab monotherapy or combined with laser showed superior BCVA improvements over laser treatment alone in Asian patients with visual impairment resulting from DME. No new ocular or nonocular safety findings were observed and treatment was well tolerated over 12 months.

Ocular adnexal IgG4-related disease: clinical features, outcome, and factors associated with response to systemic steroids.

PURPOSE: The aim of this study was to investigate clinical characteristics, outcome, and factors associated with response to systemic administration of steroids in patients with ocular adnexal immunoglobulin G4 (IgG4)-related disease. METHODS: This was a retrospective evaluation of 11 patients with histopathologically verified ocular adnexal IgG4-related diseases at a medical center in Taiwan between January 2006 and December 2012. Clinical features and outcome, including serial change of serum IgG4 and clinical factors related to response to steroids systemically were evaluated. RESULTS: Seven men and four women, mean age 54.5 years and mean follow-up of 33.5 months, were evaluated. Elevated serum IgG4 levels (>135 mg/dl) were observed in ten patients (91%). Lacrimal gland involvement was noted in eight (72.7%), followed by orbit, extraocular muscles, and eyelids. Seven patients (63.6%) had bilateral ocular lesions and eight (72.7%) had extraorbital involvement. Eight of ten patients who underwent systemic steroid treatment responded well in the early phase. Recurrence developed in five patients (45%), requiring repeat steroid therapy and adjunctive treatment. Median serum levels of IgG4 reduced from 540 to 101 mg/dl in ten patients after systemic corticosteroid administration. Patients with lower serum IgG4 and IgG4:IgG ratio at diagnosis were associated with poor response (p = 0.037). CONCLUSIONS: Ocular adnexal IgG4-related disease predominantly involved the lacrimal glands bilaterally and was usually associated with high serum IgG4 levels and multiple organ involvement. Most patients responded well to steroid therapy, which was accompanied by a marked decrease in serum IgG4.

Retinal detachment with a break at pars plicata associated with congenital malformation of the lens-zonule-ciliary body complex.

Retinal detachment with a break at the pars plicata associated with congenital malformation of lens-zonule-ciliary body complex is rare; most reports are of young Japanese male patients with atopic dermatitis. The present case report is the first to describe the condition in a Chinese patient with no atopic dermatitis or trauma history. A 22-year-old male presented with blurred vision in the left eye for 4 months. Fundus examination revealed shallow lower temporal retinal detachment. Further examination with scleral indentation under maximal pupil dilatation identified a break at the far periphery beyond the ora serrata and pars plana. Gonioscopy revealed a pars plicata break at the nonpigmented ciliary epithelium associated with congenital ciliary process hypoplasia and subtle lens defect at the same meridian. The retina was successfully reattached after segmental scleral buckling, cryopexy, and laser photocoagulation.

Adjunctive Orbital Radiotherapy for Ocular Adnexal IgG4-related Disease: Preliminary Experience in Patients Refractory or Intolerant to Corticosteroid Therapy.

PURPOSE: To present the clinical outcomes of combined orbital radiotherapy and systemic corticosteroid for patients with refractory ocular adnexal IgG4-related disease. METHODS: We retrospectively reviewed 3 patients with histopathologically confirmed ocular adnexal IgG4-related disease who had been refractory or intolerant to corticosteroid therapy and treated with adjunctive orbital radiotherapy (2000 cGy; 10 fractions). Clinical improvement was assessed by monitoring the patient's ability to taper corticosteroid to discontinuation and by follow-up radiologic examination. RESULTS: All 3 patients had a favorable response to adjunctive radiotherapy with improvement of the clinical symptoms and radiologic abnormalities. Systemic corticosteroid was tapered and discontinued in all patients successfully. There were no adverse effects of treatment or recurrence after a mean follow-up of 19 months. CONCLUSION: Adjunctive radiotherapy can help to achieve stable disease and cessation of systemic corticosteroid in patients with refractory ocular adnexal IgG4-related disease.

Systolic blood pressure, choroidal thickness, and axial length in patients with myopic maculopathy.

BACKGROUND: In the population-based Shihpai Eye Study, patients aged >65 years with myopic maculopathy were found to have higher systolic blood pressure. This finding deserved further exploration because this is the only correctable factor for preventing maculopathy in patients with high myopia. Therefore, we investigated the association between myopic maculopathy and systolic blood pressure, as well as other ocular parameters in this study. METHODS: A clinic-based, retrospective cross-sectional study at a medical center was conducted between February 2011 and October 2012. Patients with high myopia were included and medical charts were reviewed. High myopia was defined as axial length ≥26.5 mm in at least one eye. Myopic maculopathy was defined as the presence of lacquer cracks, focal areas of deep choroidal atrophy, diffuse chorioretinal atrophy, and macular choroidal neovascularization or geographic atrophy in the presence of high myopia. Systolic blood pressure measurements were collected, and fundus photography and optical coherence tomography were performed. Subfoveal choroidal thickness (SFCT) shown on optical coherence tomography was measured and recorded. RESULTS: The medical records of 187 high-myopic patients (87 without and 100 with maculopathy) were reviewed. Patients with maculopathy were older (56.96 years vs. 42.95 years, p < 0.01), had longer axial length (29.96 mm vs. 27.31 mm, p < 0.01), thinner SFCT (49.71 µm vs. 155.77 µm, p < 0.01), higher systolic blood pressure (132.28 mmHg vs. 125.31 mmHg, p < 0.05), greater prevalence of hypertension (31% vs. 16%, p < 0.05), and longer history of hypertension (2.34 years vs. 0.59 years, p < 0.01) compared to patients without maculopathy. After multivariate adjustment, SFCT and axial length were the only significant factors for maculopathy. CONCLUSION: Thinner SFCT and longer axial length are significant risk factors for myopic maculopathy. Unlike previous epidemiological surveys, results of this clinic-based study suggested that systolic blood pressure is not a significant factor for maculopathy.

Management and clinical outcomes of intraocular foreign bodies with the aid of orbital computed tomography.

BACKGROUND: Computed tomography (CT) is known to be the first-line imaging method for patients with or suspect to have intraocular foreign bodies (IOFBs). The purpose of this study is to evaluate clinical outcomes in the management of IOFBs with the aid of CT. METHODS: Retrospective chart review of patients who received orbital CT prior to the removal of an IOFB between January 2000 and December 2010 was carried out. Patients with an IOFB who did not receive an operation or those without a preoperation CT examination were excluded. Twenty patients with a mean age of 37 years were selected. The duration between injury and surgery ranged from hours to 4 months. Detailed information and ophthalmologic examination results including patient history, visual acuity (VA), slit-lamp examination, fundoscopic examination, operation notes and bacterial culture results were recorded for all patients. The orbital CT images were performed with multidetector CT scanners with a 2-3.75 mm slice thickness. RESULTS: This study found 18 patients (90%) with only one IOFB on CT image, in which only nine IOFBs were discovered on clinical assessment. The CT image failed to discover the IOFB in two patients who had tiny iron dust fragments located in the cornea stroma or embedded in the lens. Preoperative determination of the IOFB size and location was helpful in the decision-making of the route of extraction. Further, there was a correlation between clinical presentation about vitreous hemorrhage and the development of postoperative retinal detachment (Fisher's exact test, p = 0.029). The presence of positive bacterial cultures was also found to be associated with decreased VA (Fisher's exact test, p = 0.047). The injured eyes were anatomically preserved in all patients. However, two patients had loss of light perception. Eleven patients (55%) had improved VA of more than two lines on Snellen's chart, seven patients worsened, and two patients retained the same initial VA. CONCLUSION: Multidetector CT plays an important role in the detection, localization, size measurement, and surgical approach towards the extraction of the IOFB. The presence of vitreous hemorrhage is a predictive factor for postoperative retinal detachment, and positive bacterial cultures result in poorer visual outcomes.

Persistent exudative retinal detachment after photodynamic therapy and intravitreal bevacizumab injection for multiple retinal capillary hemangiomas in a patient with von Hippel-Lindau disease.

Photodynamic therapy (PDT) has been used in treating peripheral retinal capillary hemangioma (RCH) with satisfactory results. We report a rare case of von Hippel-Lindau (VHL) disease with three large peripheral RCHs, treated with PDT and intravitreal bevacizumab injection (IVB), who developed persistent bullous exudative retinal detachment (RD) despite significant tumor regression. The patient is a sporadic case of VHL disease, with a de novo nonsense mutation in codon 161 with C → T transition at nucleotide position 694 of the VHL gene. Multiple RCHs were noted in both eyes. Four small RCHs were found in the left eye and were treated with laser photocoagulation. Three large RCHs in the peripheral retina of the right eye were complicated with cystoid macular edema and subretinal fluid accumulation. The RCHs were treated with PDT combined with IVB, and bullous exudative RD developed on the second day after treatment. Three months after PDT, the tumors had regressed significantly, but exudative RD persisted, despite multiple IVB and intravitreal triamcinolone acetonide injection (IVTA). External drainage with sclera buckling, IVB, and IVTA were performed, and the retina attached after surgical intervention. The application of PDT in the treatment of RCHs and its possible complications are discussed.

Comparison of the effect of reduced-fluence photodynamic therapy with intravitreal bevacizumab and standard-fluence alone for polypoidal choroidal vasculopathy.

BACKGROUND: Photodynamic therapy (PDT) has previously been reported to be effective in treating polypoidal choroidal vasculopathy (PCV), with satisfactory polyp regression. However, the optimum treatment protocol remains controversial. This study compared the effect of reduced-fluence PDT combined with intravitreal bevacizumab (rPDT/IVB) and standard-fluence PDT (sPDT) alone for treating symptomatic PCV in Chinese patients. METHODS: A retrospective review was carried out of the medical records of patients with PCV who were treated with rPDT/IVB (14 eyes of 13 patients) or sPDT (12 eyes of 12 patients) with at least 6 months of follow-up. RESULTS: The mean best-corrected visual acuity of the rPDT/IVB group improved significantly at the 6-month follow-up (p = 0.041). Only one eye (7.1%) in the rPDT/IVB group showed a decrease in visual acuity, compared with four eyes (33.3%) in the sPDT group. A total of 40.0% of eyes in the sPDT group showed increased lipid exudate at follow-up 1 month after treatment, whereas no increase in lipid exudate was observed in the rPDT/IVB group (p = 0.015). The mean maximum area of post-treatment hemorrhage in the rPDT/IVB group was smaller than that in the sPDT group (2.57 ± 2.74 mm(2) vs. 12.69 ± 10.28 mm(2), p = 0.042). CONCLUSION: Combination therapy with rPDT/IVB for patients with PCV showed encouraging results in vision improvement, a lower decrease in visual acuity, significantly less post-treatment lipid exudate and a smaller area of post-treatment hemorrhage at the 6-month follow-up than patients treated with sPDT.

The protective effect of antioxidants on orbital fibroblasts from patients with Graves' ophthalmopathy in response to oxidative stress.

PURPOSE: To investigate the biphasic effects of hydrogen peroxide (H2O2) on the orbital fibroblasts of patients with Graves' ophthalmopathy (GO) and the relation to antioxidants and proinflammatory cytokines. METHODS: Proliferation of cultured orbital fibroblasts from patients with GO and normal controls was evaluated in response to various concentrations of H2O2. The effect of low concentrations of H2O2 (6.25 µM) on the cellular proliferation and induction of intracellular proinflammatory cytokines, and reactive oxygen species of orbital fibroblasts were assessed. Protective effects of N-acetylcysteine and vitamin C on GO fibroblasts in response to 6.25 µM H2O2 stimulation were also investigated. RESULTS: When the GO fibroblasts were exposed to H2O2 at a concentration of 50 µM or above, significant cytotoxicity was observed. In contrast, lower concentrations of H2O2 (3.125-25 µM) increased the survival of GO fibroblasts with the peak cellular proliferation at 6.25 µM H2O2. However, this biphasic effect of H2O2 on the viability of orbital fibroblasts was not found in normal controls. In addition, 6.25 µM H2O2 led to significant elevation of the levels of transforming growth factor, beta 1, interleukin-1ß, and superoxide anion in GO fibroblasts, but no significant change in the normal controls. Pretreatment with N-acetylcysteine or vitamin C reversed the enhanced proliferation capacity and the induction of transforming growth factor, beta 1, interleukin-1ß and superoxide anion of GO fibroblasts in response to 6.25 µM H2O2. CONCLUSIONS: These findings revealed the biphasic effect of H2O2 on cellular proliferation of GO orbital fibroblasts. Importantly, a low level of H2O2 can stimulate proliferation of GO orbital fibroblasts and induce the production of proinflammatory cytokines, which can be inhibited by pretreatment with antioxidants. This provides a theoretical basis for the rational use of antioxidant in treating GO at an early stage.

Lacrimal gland pleomorphic adenoma masquerading as thyroid-associated ophthalmopathy.

Thyroid-associated ophthalmopathy is the most common cause of proptosis in adult female, especially those with positive thyroid antibody. Sometimes, other diagnoses should be considered. A 45-year-old female presented with progressive right proptosis and mild diplopia for 2 years. One year earlier, she had been diagnosed with thyroid-associated ophthalmopathy because of abnormal thyroid autoantibody. Computed tomography scan showed a 2.4- × 1.9- × 1.6-mm heterogeneous soft-tissue density lying above the left eye. Excisional biopsy of this mass revealed the histopathologic diagnosis of pleomorphic adenoma. This case highlights the need for including other diagnoses such as pleomorphic adenoma in the differential diagnosis of patients with proptosis, diplopia and abnormal thyroid antibody.

Short-term external buckling with pneumatic retinopexy for retinal detachment with inferior retinal breaks.

PURPOSE: To introduce a new approach for short-term external scleral buckling with pneumatic retinopexy for the management of rhegmatogenous retinal detachment with inferior retinal breaks. DESIGN: Retrospective, noncomparative, interventional case series. METHODS: A review of 33 consecutive eyes of 31 patients who underwent external buckling with pneumatic retinopexy for uncomplicated rhegmatogenous retinal detachment with inferior retinal breaks from December 2006 through December 2010. An external buckle was made of a 505 sponge sutured along the blunt side of a 279 tyre (MIRA Inc). The buckle was inserted deeply into the inferior fornix without suture after pneumatic retinopexy and was kept in place for 3 days. Primary and final anatomic outcomes, visual acuity, and adverse events were recorded. RESULTS: All patients tolerated the procedure. The mean follow-up period was 24.0 months (range, 9 to 61 months). Primary success, defined as successful retinal reattachment within 6 months without further treatment, was achieved in 29 (87.9%) eyes. All patients attained final retinal reattachment (100%). Overall, the mean best-corrected visual acuity improved significantly at the end of follow-up (0.30 logarithm of the minimal angle of resolution units; Snellen equivalent, 6/12), compared with the preoperative best-corrected visual acuity (0.82 logarithm of the minimal angle of resolution units; Snellen equivalent, 6/38; P < .001). CONCLUSIONS: Short-term external buckling with pneumatic retinopexy is a novel and effective treatment for rhegmatogenous retinal detachment with inferior retinal breaks, with a comparable success rate with other treatment methods. This approach also can avoid complications of long-term buckle implantation. Further comparative cohort studies may be necessary to compare the clinical efficacy with other conventional operations.

Optical coherence tomography in resolution of photoreceptor damage in multiple evanescent white dot syndrome.

Multiple evanescent white dot syndrome (MEWDS) is an acute-onset chorioretinal inflammatory disease. This disorder is characterized by unilateral multiple gray-white dots of the posterior pole in young healthy women. Symptoms include blurred vision, photopsia, and visual field (VF) defects. Although the etiology of MEWDS is still unknown, most patients have spontaneous improvement in vision and fundus appearance within a period of weeks. Herein, we report a typical case of MEWDS, and describe the spontaneous resolution of photoreceptor damage during the entire course, demonstrated by serial optical coherence tomography (OCT). The OCT is a sensitive and noninvasive tool for the diagnosis and serial microstructure evaluation of patients with MEWDS.