Choriocapillaris flow voids by optical coherence tomography–angiography in a patient with probable secondary multiple evanescent white dot syndrome

Purpose: To report a rare case of probable secondary multiple evanescent white dot syndrome (MEWDS) with optical coherence tomography angiography (OCTA)-demonstrated choriocapillaris flow voids in the absence of pre-existing macular pathology. Methods: A 24-year-old man who presented with blurred vision and a central scotoma underwent multimodal imaging and was monitored without treatment for 5 months. Results: Fundus imaging revealed classic MEWDS-like white dots at the posterior pole with corresponding ellipsoid zone disruption on OCT. OCTA demonstrated localized choriocapillaris flow voids in the absence of any preexisting macular pathology. Clinical signs and imaging abnormalities resolved spontaneously on follow-up, with restoration of both choriocapillaris flow and outer retinal structure. Conclusion: OCTA-detected choriocapillaris flow voids in this case of probable secondary MEWDS resolved progressively over 5 months. These hypothesis-generating findings suggest a potential role for choriocapillaris dysfunction in secondary MEWDS and underscore the diagnostic and monitoring value of OCTA in this setting. Prospective studies in larger cohorts are needed to validate these observations.