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Multiple evanescent white dot syndrome: case report A 34-year-old man developed multiple evanescent white dot syndrome (MEWDS) following vaccination with influenza-vaccine (optaflu). The man, who had undergone a myopic-photorefractive keratectomy, presented with a 2-week history of para-central scotomata, grey haze and central photopsias affecting his right eye. Snellen visual acuity was found to be 20/20+2 and 20/13-1 in the right and left eye, respectively. Intraocular pressure was 18mm Hg in the right eye and 14mm Hg in the left eye. Pupils, extraocular motility and confrontation visual fields were unremarkable. Anterior segment examination was also found to be normal. Examination of the right-sided posterior segment was notable for mild foveal granularity and small, grey, outer-retinal lesions centered around the optic nerve with extension to the mid-periphery. The posterior segment of the left eye was unremarkable. At the locations of the grey retinal lesions, spectral domain-optical coherence tomography demonstrated focal areas photoreceptor disruption, fundus autofluorescence showed hyper-autofluorescence, indocyanine green angiography revealed late hypofluorescence and fluorescein angiography revealed multiple punctate areas of staining organised in a well-recognised wreath-like pattern. Based on the presenting symptoms and multimodal imaging (MMI) findings, a diagnosis of MEWDS was made. Upon further investigation, he declined any previous viral symptoms. However, he reported that he had received intradermal influenza-vaccine (optaflu) [flucelvax quadrivalent influenza vaccine; dosage not stated] 2 weeks prior to the onset of symptoms. The man was observed without intervention. At 4-week follow-up, his symptoms and the abnormal multimodal imaging findings had resolved. Additonally, improvement in Snellen visual acuity was noted with 20/16-1 in the right eye at his last visit. Ng CC, et al. Multiple evanescent white dot syndrome following influenza immunization - A multimodal imaging study. American Journal of Ophthalmology Case Reports 803500467 19: 1-4, Sep 2020. Available from: URL: http://doi.org/10.1016/j.ajoc.2020.100845

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Reactions 12 Sep 2020 No. 1821