Opposing pathophysiological concepts in multiple evanescent white dot syndrome: The great MEWDS schism
Rattachement africain : gb, sa, tw, pt, jp. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
Multiple evanescent white dot syndrome (MEWDS) is a benign posterior uveitis involving the outer retina-choriocapillaris complex. The clinical picture, since its first description in 1984, is well-established. Classified at the benign end of the choriocapillaritis spectrum, including, among others, idiopathic multifocal choroiditis, serpiginous choroiditis, and acute posterior multifocal pigment epitheliopathy, a challenge to this classical choriocapillaritis classification of the disease was attempted, attributing the primary lesion process to a photoreceptoritis. The aim of this perspective and review article was to gather a sufficient body of evidence for a credible pathophysiological explanation of MEWDS. We reviewed the literature and integrated the results of some of our own studies on MEWDS. The crucial role of indocyanine green angiography (ICGA) and its correct interpretation is highlighted, giving clear indications that uptake failure of ICG by the retinal pigment epithelial (RPE) cannot explain ICGA hypofluorescence. In contrast to what is often claimed, ICGA hypofluorescence is already present in the early angiographic phases in MEWDS, speaking for a perfusion problem rather than the RPE nonuptake thesis. Hypoxic damage principally affects the photoreceptor cell but only minimally the RPE cell in MEWDS, explaining why primary photoreceptoritis has been privileged by some. The principles of optical coherence tomography angiography, being based on the presence of flow, it cannot detect the presence or absence of flow in low-flow end-capillaries and is, therefore, an inappropriate imaging modality for MEWDS. There is a continuum between MEWDS and other choriocapillaritis entities, which are all based on inflammatory choroidal circulatory dysfunctions of diverse severity, including MEWDS. We found a substantial body of evidence indicating that end-choriocapillaris nonperfusion is at the origin of MEWDS with limited secondary hypoxic damage mainly to the vulnerable photoreceptors and functional preservation of the metabolically more resistant RPE cell. As only small end-choriocapillary vessels are involved in MEWDS, spontaneous resolution of the disease occurs mostly without sequels.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Opposing pathophysiological concepts in multiple evanescent white dot syndrome: The great MEWDS schism
- Date Crossref
- 01/10/2025
- Éditeur
- Ovid Technologies (Wolters Kluwer Health)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Moorfields Eye Hospital Uveitis Department pays non établi dans la noticeÉtablissement de santé
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University College London pays non établi dans la noticeUniversité ou école supérieure
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King Saud University pays non établi dans la noticeUniversité ou école supérieure
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National Yang Ming Chiao Tung University pays non établi dans la noticeUniversité ou école supérieure
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Taipei Veterans General Hospital Department of Ophthalmology pays non établi dans la noticeÉtablissement de santé
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Administração Regional de Saúde de Lisboa e Vale do Tejo pays non établi dans la noticeOrganisme public
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Taichung Veterans General Hospital Department of Ophthalmology pays non établi dans la noticeÉtablissement de santé
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The University of Osaka pays non établi dans la noticeUniversité ou école supérieure
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National Defense Medical College pays non établi dans la noticeUniversité ou école supérieure
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Tokyo Medical University Department of Ophthalmology pays non établi dans la noticeUniversité ou école supérieure
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Retinal and Inflammatory Eye Diseases pays non établi dans la noticeInstitution
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College of Medicine Department of Ophthalmology pays non établi dans la noticeUniversité ou école supérieure
Uveitis Department — Moorfields Eye Hospital, University College London et King Saud University, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.