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Acute idiopathic blind spot enlargement (AIBSE) syndrome is characterized by an enlarged blind spot that can occur either as an isolated finding or as a part of several other chorioretinopathies, such as acute zonal occult outer retinopathy (AZOOR), acute macular neuroretinopathy (AMN), multiple evanescent white dot syndrome (MEWDS), and multifocal choroiditis and panuveitis (MCP). Current belief is that these entities are a spectrum of outer retinal inflammatory disorders that regardless of etiology may result in overlapping clinical features. 1–3

ICON is a fusion protein composed of factor VII, the natural ligand for tissue factor, conjugated to the Fc domain of a human IgG1 immunoglobulin. It binds to the tissue factor expressed on neovascular endothelia and initiates a cytolytic immune attack that destroys the neovascular tissue. We previously showed that mouse factor VII-Fc chimeric antibody (mICON) dramatically decreases the frequency of choroidal neovascularization in a laser-induced choroidal neovascularization model in mice. Herein, we determined the safety and efficacy of mICON in destroying subretinal choroidal neovascularization in pig eyes.mICON (150-1200 microg) was administered into the midvitreous cavity of the pig eye either before (on Day 0) or after (on Day 10) induction of choroidal neovascularization with laser photocoagulation. On Day 14, the incidence of choroidal neovascularization was determined using confocal microscopy. We also determined the binding specificity (% binding to choroidal neovascularization/% binding to non-choroidal neovascularization areas) of mICON to tissue factor expressed on endothelial cells of laser-induced choroidal neovascularization.We observed that mICON selectively destroyed choroidal neovascularization in a dose-dependent manner (r = -0.93; EDB50B = 571.3 microg). Obliteration of the choroidal neovascular complex was more prominent at doses300 microg (p0.05). No systemic or local complications (including retinal tear/detachment, inflammation, infection, cataract, or glaucoma) were observed. Binding specificities of hICON (2.2 +/- 0.2) and mICON (3.4 +/- 0.4) were significantly higher than that of anti-von Willebrand antibody (0.1 +/- 0.01, p0.001).Both hICON and mICON bound to the neovascular endothelia of choroidal neovascularization with greater specificity than anti-von Willebrand antibody. Furthermore, mICON can selectively obliterate already established choroidal neovascularization, which suggests that it may be useful for immunotherapy in patients with exudative (wet) macular degeneration.

Purpose: To report simultaneous occurrence of multiple evanescent white dot syndrome (MEWDS) and multifocal choroiditis (MFC) in the same eye of a 33-year-old Caucasian woman.Methods: Review of clinical and fluorescein angiographic features of a patient who presented with decreased visual acuity and was followed for 3 months.Results: Patient presented with concurrent lesions of MEWDS and MFC occurring in the same eye. During the follow-up period MEWDS lesions resolved and MFC lesions evolved into chorioretinal scars.Conclusions: Simultaneous development of MEWDS and MFC may indicate a possible common causal entity.

In the past two years a major shift has occurred in the treatment paradigm for exudative AMD. Traditional palliative treatments, such as thermal laser photocoagulation and photodynamic treatment, h...