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Aim: To examine fundus autofluorescence (FAF) findings in eyes with presumed idiopathic outer lamellar defects (OLD) at the fovea and to discuss their pathogenesis. Methods: Prospective observational case series of five eyes of four patients presenting with OLD at the fovea defined as discrete lesions of 50-100μm in size located at the level of the outer retina on biomicroscopy and imaged on optical coherence tomography (OCT) as cylindric, well demarcated interruption of both hyperreflective bands corresponding to the inner/outer segments junction of photoreceptors and to the complex retinal pigment epithelium-choriocapillaris; none of the enrolled patients had history positive for direct sungazing, welding-arc or sunbed exposure, whiplash injury, ocular trauma, macular oedema/detachment or evidence of vitreo-macular traction. The corresponding FAF images were evaluated. Results: In eyes with OLD the neuroretina in the foveal region appeared to be thinner in comparison to fellow, unaffected eyes. FAF revealed well demarcated, hypoautofluorescent areas (corresponding in location to the OLD observed clinically and on OCT), surrounded by an irregular halo of relatively increased autofluorescence in the context of the greater hypoautofluorescent macular region. Conclusion: Biomicroscopy, OCT and FAF findings of presumed idiopathic OLD of the fovea strongly resembles those observed in association to chronic solar retinopathy. In association to OCT, FAF might represent an useful tecnique to detect subtle solar-induced injuries of the retina.

Objectives: To study the relationship between different fluorescein and indocyanine green angiographic features in a case series of multiple evanescent white dot syndrome (MEWDS) and to gain insight into its pathophysiological nature. Methods: Retrospective review of seven patients (eight eyes) with MEWDS (selected based on clinical and angiographic manifestations of the disorder) examined using slit-lamp biomicroscopy and studied using fluorescein angiography (FA) and indocyanine green angiography (ICGA). Results: In the clinically affected eyes, FA early phases revealed hyperfluorescence in 3 eyes and a combination of hyper and hypofluorescence in 5 eyes; the following relationships between FA and ICGA were found: 1) areas of early hypo- and late hyperfluorescence (staining and leakage) on FA corresponding to areas of early hypo and late hypo-,iso or hyperfluorescence on ICGA; 2) early and late hyperfluorescence (staining but very faint, if any, leakage) on FA corresponding to normal early ICGA and intermediate-late hypofluorescence; 3) areas of hypo- and hyperfluorescence on ICGA without a clear counterpart on FA. Conclusions: Angiographic features may vary in eyes with similar clinical signs of MEWDS. Such variability could reflect the different anatomic structures involved during the natural evolution of the disease. Angiographic studies suggest that both, inner and outer choroid, are involved in this disorder. The final outcome is not affected by the initial angiographic presentation.

The purpose of the study was to investigate the natural evolution of fundus autofluorescence (FAF) findings in eyes with multiple evanescent white dot syndrome.This was a retrospective, observational case series of nine eyes of eight consecutive patients with multiple evanescent white dot syndrome who underwent color fundus photographs, fluorescein and indocyanine green angiography, and FAF photography in two referral practices.The mean follow-up was 8.6 months (range, 3-14 months). In the acute/ subacute phase, FAF showed 1) hypoautofluorescent areas, ≤50 μm in size, mostly concentrated around the optic disk and posterior pole; and 2) areas of increased autofluorescence usually found in correspondence to the white dots seen ophthalmoscopically. During the follow-up period, some of the hypoautofluorescent areas faded away, others persisted; the areas originally showing increased autofluorescence variably tended to: 1) become smaller and more demarcated; 2) retract centripetally becoming small hyper-autofluorescent areas surrounded by an hypoautofluorescent halo; 3) turn into areas of decreased autofluorescence; or 4) disappear without becoming hypofluorescent.Multiple evanescent white dot syndrome represents a unique model to study the natural evolution of FAF findings in chorioretinal affections, from the acute phase to resolution; FAF findings, evaluated along with fluorescein and indocyanine green angiography features, can expand our understanding about retinal pigment epithelium and retinal involvement in this rare chorioretinal disorder.