Purpose: To describe three unusual clinical cases of patients who were diagnosed with multiple evanescent white dot syndrome at the onset of their disease but lacked the characteristic white dots on clinical examination, autofluorescence, and angiographic testing at any time during their follow-up. Methods: Three eyes of three patients with clinical symptoms of multiple evanescent white dot syndrome seen at an academic clinical practice were included. Retinal imaging, including fluorescein angiography, indocyanine green imaging, fundus autofluorescence, and optical coherence tomography, was used to further characterize and describe the clinical findings. Results: All three patients presented with classic multiple evanescent white dot syndrome complaints. All patients demonstrated classic foveal granularity and mild disk swelling and/or peripapillary whitening. No characteristic hyperfluorescent lesions were seen on fluorescein angiography, and indocyanine green imaging did not demonstrate typical patterns of hypofluorescence and/or leakage. Optical coherence tomography documented focal disruption or loss of the inner segment/outer segment photoreceptor line in all cases. Conclusion: Our case series demonstrates another atypical presentation of multiple evanescent white dot syndrome that has not been described previously: foveal involvement at the onset of the disease without white spots.
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