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MULTIFOCAL ELECTRORETINOGRAPHY IN MULTIFOCAL CHOROIDITIS AND THE MULTIPLE EVANESCENT WHITE DOT SYNDROME

OH, KEAN T. MD*; FOLK, JAMES C. MD; MATURI, RAJ K. MD; MOORE, PAULA; KARDON, RANDY H. MD, PHD

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Purpose To study and compare the findings on multifocal electroretinography (MERG) between multifocal choroiditis (MFC) and the multiple evanescent white dot syndrome (MEWDS).

Subject and Methods Patients were recruited prospectively from the Department of Ophthalmology & Visual Sciences at the University of Iowa Hospitals & Clinics. They were evaluated using Goldmann visual fields (GVF) and MERG. Patients were diagnosed as having either MFC or MEWDS based on their clinical findings before MERG testing.

Results Nineteen patients (23 eyes) were included in the study. Eleven patients were diagnosed with MFC and eight patients with MEWDS. Fourteen eyes with MFC and seven eyes with MEWDS were tested with MERG during the acute phase of their respective conditions. Fourteen patients (8 MFC and 6 MEWDS) were followed serially with MERG. Patients with MEWDS demonstrated focal depression corresponding to GVF defects with subsequent near total recovery of the MERG to baseline. Patients with MFC typically demonstrated diffuse loss of function over the entire test field. Focal scotomata, in addition to the diffuse depression, could be identified in 7 of 14 patients. Patients with MFC demonstrated only partial or no recovery of MERG following acute episodes, which was significantly different from the course followed by patients with MEWDS (P < 0.001, Fisher’s exact test).

Conclusion Multifocal electroretinography differentiates MFC from MEWDS. Patients with MFC have permanent damage to the retina with diffuse depression of MERG. Patients with MEWDS, however, typically demonstrate greater focal loss initially on MERG followed by nearly full recovery of first order retinal function.

*University of North Carolina, Chapel Hill; † the Department of Ophthalmology and Visual Sciences, The University of Iowa Hospitals & Clinics, Iowa City; and the ‡ Midwest Eye Institute, Indianapolis, Indiana.

Reprint requests: James C. Folk, Department of Ophthalmology and Visual Sciences, The University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52242-1091.

This work was supported in part by an unrestricted grant from Research to Prevent Blindness (New York), a grant from Zeiss-Humphrey corporation (Dr. Kardon), and a Veteran’s Administration Merit Review Grant (Dr. Kardon). Dr. Kardon is also a Lew Wasserman Scholar (Research to Prevent Blindness).

Kean T. Oh is a Heed & Knapp Foundation Fellow for 1999–2001 and a Ronald G. Michels Foundation Fellow for 1999–2000.

© The Ophthalmic Communications Society, Inc.