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Background To describe the prevalence and causes of visual impairment and blindness in North Africa and the Middle East (NAME) in 1990 and 2010. Methods Based on a systematic review of medical literature, we examined prevalence and causes of moderate and severe vision impairment (MSVI; presenting visual acuity <6/18, =3/60) and blindness (presenting visual acuity <3/60). Results In NAME, the age-standardised prevalence of blindness decreased from 2.1% to 1.1% and MSVI from 7.1% to 4.5%. In 2010, 3.119 million people were blind, and 13.700 million had MSVI. Women were generally more often affected than men. Main causes of blindness were cataract, uncorrected refractive error, macular degeneration and glaucoma. Main causes of MSVI were cataract and uncorrected refractive errors. Proportions of blindness and MSVI from trachoma significantly decreased. Conclusions Although the absolute numbers of people with blindness and MSVI increased from 1990 to 2010, the overall age-standardised prevalence of blindness and MSVI among all ages and among those aged 50 years and older decreased significantly ( p<0.05). Cataract and uncorrected refractive error were the major causes of blindness and MSVI. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine predictive factors for low final visual acuity in patients with inactive Vogt-Koyanagi-Harada (VKH) disease using Swept-source OCT and OCT-angiography (OCT-A). Methods: We conducted a prospective longitudinal study, including 21 patients (42 eyes), who were followed up for the first 24 months after disease onset. Patients were included at the acute phase and subsequently treated. Sequential qualitative and quantitative changes in OCT and OCT-A were assessed. Analytical statistical methods were employed to determine predictive factors for final visual acuity. Results: Structural alterations including focal parafoveal outer nuclear layer atrophy, ellipsoid zone disruption, interdigitation zone disruption, and irregular and thickened retinal pigment epithelium line were observed in 57.1% of eyes at month 3, with no significant improvement over time. The presence of flow voids at months 6, 12, and 24 was significantly associated with low final visual acuity. Serous retnal detachment at presentation emerged as an independent risk factor for structural changes detected by SS-OCT during the first 2 years of the disease. Optic disc edema was predictive factor for both structural SS-OCT and OCT-A changes. Conclusion: This study underscores the importance of monitoring flow voids to predict final visual acuity and highlights the impact of serous retinal detachment at presentation on structural changes in patients with inactive VKH disease. [ABSTRACT FROM AUTHOR]

To compare clinical profile and visual outcomes of occlusive versus non-occlusive retinal vasculitis (RV). A retrospective comparative study 284 patients were enrolled, including 124 patients with occlusive RV (ORV) and 160 patients with non-occlusive RV (NORV). Patients with ORV were older (p ≤ 10–3), predominantly male (p ≤10-3), with less bilateral involvement (31.5% vs 53,4%; p ≤ 10−3). Infectious RV was more frequently diagnosed in the ORV group than in the NORV group (48.8% vs 32.9%, p =.006). Behçet disease and ocular tuberculosis were the leading causes of ORV. Idiopathic RV, Behçet disease, and sarcoidosis were the most common causes of NORV. Independent predictive factors of poor visual outcome were worse baseline visual acuity in both groups (p =.006 and p ≤ 10–3, respectively), and retinal hemorrhages (p =.048) and optic atrophy (p =.040) in the ORV group. Occlusive and non-occlusive RV have distinctive clinical and etiological profile. [ABSTRACT FROM AUTHOR]

To report a case of unilateral acute foveolitis following COVID-19 vaccination. A case report. A 24-year-old woman developed a sudden blurring of vision in the left eye (LE) 5 days after receiving the first dose of COVID-19 vaccine. Examination of the LE showed a visual acuity at 20/40, 2+ cells in the vitreous, and a small yellow-orange foveal subretinal lesion. Late-phase fluorescein angiography showed a mild diffuse retinal vascular leakage and a faint foveal hyperfluorescence. ICG angiography showed in the late-phase hypofluorescence of the centrofoveal lesion. OCT B-scan demonstrated a conical hyperreflective subfoveal lesion on the retinal pigment epithelium associated with disruption of the outer retinal layers. En-face OCT revealed granular hyperreflective specks mainly in the inner nuclear layer. Work-up results were unremarkable. The patient received oral prednisolone with subsequent full functional and anatomic recovery. Foveolitis may rarely occur as a complication of COVID-19 vaccination. [ABSTRACT FROM AUTHOR]

Aims/Purpose: To investigate the size and shape of the foveal avascular zone (FAZ) after successful macula‐off rhegmatogenous retinal detachment (RRD) repair using swept source OCT angiography (SS OCTA). Methods: A prospective comparative cross‐sectional study including 21 eyes of 21 patients with macula‐off RRD that were successfully repaired. The size of the superficial FAZ was assessed by its area, length of perimeter, and Feret's diameter, and the shape by the circularity, axial ratio, roundness and solidity. The correlations between each parameter and the clinical and OCT findings were statistically determined. The unaffected fellow eyes were used as controls. Results: The mean initial BCVA was 1.92 ± 0.41 Log MAR (20/2000 Snellen's equivalent). The mean BCVA at OCTA acquisition (3 months) was 0.78 ± 0.39 Log MAR (20/100 Snellen's equivalent) (p < 0.001). FAZ was significantly larger (323.09 ± 129.03 μm2 vs. 245.27 ± 93.15 μm2; p = 0.038), with longer perimeter (2.31 ± 0.35 mm vs. 2.07 ± 0.31 mm; p = 0.048), and irregular shaped (mean circularity: 0.73 ± 0.72 vs. 0.78 ± 0.5; p = 0.019 and mean solidity: 0.90 ± 0.02 vs. 0.93 ± 0.02; p = 0.002) in operated eyes than in the control group. The average Feret's diameter was 0.77 ± 0.10 mm versus 0.71 ± 0.88 mm (p = 0.076). The average axial ratio was 1.25 ± 0.20 versus 1.22 ± 0.22 (p = 0.531), and the average roundness was 0.81 ± 0.11 versus 0.83 ± 0.11 (p = 0.531). Mean central foveal thickness (CFT) was significantly lower in operated eyes than in control eyes (178.23 ± 40.59 μm vs. 247.44 ± 38.2 μm (p < 0.001)). There was a significant inverse correlation between FAZ area and post‐operative outer nuclear layer thickness (r = −0.520, p = 0.016) and CFT (r = −0.571, p = 0.007) in operated eyes. There was no significant correlation between the post‐operative visual acuity and FAZ parameters. Conclusions: Enlargement and irregularities of FAZ after successful macula‐off RRD repair, as demonstrated by SS OCTA, might suggest an ischaemic macular damage caused by RRD that may affect post‐operative functional outcome. [ABSTRACT FROM AUTHOR]

Objective: To describe a case of Behçet disease (BD) uveitis manifesting with sequential bilateral neuroretinitis associated with prepapillary inflammatory vitreous exudate (PIVE). Material and methods: A single case report documented with multimodal imaging. Results: A 37-year-old man developed neuroretinitis with associated PIVE in the left eye. He was diagnosed with ocular toxoplasmosis and treated accordingly based on positive serologic testing and negative work-up for other entities, including BD. The disease course was favorable, but 1 year later a similar neuroretinitis developed in the right eye. Extraocular features of BD became evident only at the time of the second eye involvement, and the patient received corticosteroid and immunosuppressive therapy. Swept source (SS) OCT showed at the acute phase in both eyes a typical "mushroom-shaped" prepapillary hyperreflectivity of the PIVE. SS OCT angiography (OCTA) demonstrated a corresponding prepapillary hypointense area due to shadowing effect, decreasing in size while scanning deeper layers. It also detected peripapillary retinal hypervascularity in both eyes and a sectoral area of flow signal loss in the first involved left eye. Visual acuity improved following the resolution of the PIVE and associated acute inflammatory changes in both eyes. The left eye showed residual optic disc pallor and retinal nerve fiber layer defects. Conclusion: Sequential bilateral neuroretinitis associated with PIVE may occur before other clinical features of BD become evident. SS OCT and OCTA can provide useful information for the diagnosis and management of this rare, but typical, ocular manifestation of BD uveitis. [ABSTRACT FROM AUTHOR]

Purpose: To describe swept-source optical coherence tomography angiography (OCTA) findings in uveitic cystoid macular edema (CME).Methods: Prospective study of 36 eyes.Results: Cystoid black spaces were shown in the deep capillary plexus (DCP) in 36 eyes (100%) and in the superficial capillary plexus (SCP) in 6 eyes (16.7%). Grayish areas of capillary non perfusion/hypoperfusion were seen in 69.4% of eyes in the DCP (vs 25% in the SCP, p < .001). The foveal avascular zone was larger than in the control healthy eyes in the DCP (p < .001). Capillary density was lower than in the control group in the SCP (p = .001) and the DCP (p < .001). Of 11 eyes with resolved CME on OCT, 4 eyes showed complete recovery of both plexuses on OCTA. There was a persistence of areas of capillary rarefaction in 4 eyes, and of hypoperfusion/nonperfusion in 3 eyes.Conclusion: OCTA visualizes perifoveal microvascular changes in uveitic CME. [ABSTRACT FROM AUTHOR]

Purpose: To report optical coherence tomography angiography (OCT-A) findings in eyes with ocular sarcoidosis (OS) and to compare these findings with those of fluorescein angiography (FA). Methods: Observational, cross-sectional, case-control study. Patients presenting with OS involving the posterior segment were evaluated using FA, structural-OCT and OCT-A. OCT-angiograms of the superficial (SCP) and deep (DCP) capillary plexuses and choriocapillaris (CC) were qualitatively and quantitatively analyzed. Results: OCT-A seemed more sensitive than FA in detecting perifoveal capillary arcade disruptions, areas of hypoperfusion/non-perfusion and capillary abnormalities (p<0.05). Capillary hypoperfusion was more frequently detected in the DCP than in SCP, conversely capillary abnormalities were more often observed at the level of the SCP. Capillary vessel density values were significantly lower in eyes with OS than in healthy controls both at the level of DCP and CC (p<0.05). Conclusion: The depth-resolved nature of OCT-A allowed new insights on OS-induced microvascular and perfusion impairments. [ABSTRACT FROM AUTHOR]

Purpose: To report the cases of two patients who presented with acute Vogt-Koyanagi-Harada (VKH) disease and associated retinal pigment epithelium detachment (PED). Methods: 2 case reports. Case 1: A 22-year-old male patient complained of acute bilateral decrease in vision. Initial best corrected visual acuity (BCVA) was 20/63, OU. There was 1+ vitreous cells, OU, exudative retinal detachment (ERD) in the right eye (RE), and a macular deep yellow lesion suggestive of PED in the left eye (LE). Case 2: A 40-year-old female patient presented with bilateral vision blurring. BCVA was 20/40 in the RE and 20/32 in the LE. There was 1+ vitreous cells OU, bilateral optic disc swelling and retinal striae. Results: Multimodal imaging showed features of acute VKH disease with associated PED in the two patients. ERD and PED resolved under oral prednisone and cyclosporine in both cases. Conclusion: PED may rarely occur in acute VKH disease at presentation. [ABSTRACT FROM AUTHOR]

Abstract Diabetic retinopathy is a major cause of reduced visual acuity and acquired blindness. The aim of this work was to analyze functional and vascular changes in diabetic Meriones shawi (M.sh) an animal model of metabolic syndrome and type 2 diabetes. The animals were divided into four groups. Two groups were fed a high fat diet (HFD) for 3 and 7 months, two other groups served as age-matched controls. Retinal function was assessed using full field electroretinogram (Ff-ERG). Retinal thickness and vasculature were examined by optical coherence tomography, eye fundus and fluorescein angiography. Immunohistochemistry was used to examine key proteins of glutamate metabolism and synaptic transmission. Diabetic animals exhibited significantly delayed scotopic and photopic ERG responses and decreases in scotopic and photopic a- and b-wave amplitudes at both time points. Furthermore, a decrease of the amplitude of the flicker response and variable changes in the scotopic and photopic oscillatory potentials was reported. A significant decrease in retinal thickness was observed. No evident change in the visual streak area and no sign of vascular abnormality was present; however, some exudates in the periphery were visible in 7 months diabetic animals. Imunohistochemistry detected a decrease in the expression of glutamate synthetase, vesicular glutamate transporter 1 and synaptophysin proteins. Results indicate that a significant retinal dysfunction was present in the HFD induced diabetes involving both rod and cone pathways and this dysfunction correlate well with the morphological abnormalities reported previously. Furthermore, neurodegeneration and abnormalities in retinal function occur before vascular alterations would be detectable in diabetic M.sh. Highlights • Diabetes induces the alteration of scotopic and photopic pathways. • Diabetes induces a decrease in retinal thickness by OCT after 3 and 7 months of diabetes. • Apparition of exudates only after 7 months of diabetes. • Impairment of glutamate metabolism and synaptic transmission in diabetic Meriones shawi. [ABSTRACT FROM AUTHOR]

A 33-year-old patient was diagnosed with acute Vogt-Koyanagi-Harada (VKH) disease and was prescribed prednisolone (1 mg/kg/day) and azathioprine (2.5 mg/kg/day). She mistakenly took an excessively high dose (4 mg/kg/day) of prednisolone for 14 days. The erroneous dose of corticosteroids was progressively corrected. Several weeks after initial presentation, the patient developed a polymerase chain reaction-proven bilateral cytomegalovirus retinitis, with extensive occlusive arteritis in the right eye. Systemic immunosuppressive therapy was temporarily discontinued and viral retinitis was successfully managed with systemic and intravitreal ganciclovir. Corticosteroids were reintroduced to control recurrent VKH disease. Final visual acuity was 20/1000 in the right eye and 20/50 in the left eye. [ABSTRACT FROM AUTHOR]

Background: The purpose of this single case report was to report the use of anterior segment optical coherence tomography for the diagnosis and management of a retained vegetal intraocular foreign body. Results: A 23-year-old otherwise healthy male presented with a progressive vision loss in the right eye (RE). He reported a mild ocular trauma with a tree leaf 1 year ago followed by recurrent episodes of redness and pain in the RE that partially resolved after a self-medication with topical steroids. Visual acuity of the RE was limited to light perception. Slit-lamp examination of the RE showed an iris granuloma with overlying exudate and associated anterior chamber inflammatory reaction. Film X-rays, contact B-scan ultrasonography, and CT scan showed no abnormalities. Anterior segment optical coherence tomography revealed an enclaved iris foreign body. The foreign body was removed after a short course of local antibio-corticosteroid therapy. This was followed 2 months later by cataract surgery with intraocular lens implantation, with subsequent improvement of visual acuity to 20/40. Conclusions: A missed intraocular foreign body can lead to sight-threatening complications. Anterior segment optical coherence tomography may be useful for detecting non-clinically evident intraocular foreign body involving the anterior segment masquerading as chronic anterior uveitis. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and efficacy of gevokizumab for the treatment of Behçet's disease uveitis in a prospective, open-label, randomized phase 2 trial.Methods: Behçet's disease patients with new acute ocular exacerbation or at risk of exacerbation received 30 or 60 mg gevokizumab every 4 weeks intravenously or subcutaneously, on top of a stable regimen of immunosuppressives and corticosteroids (≤20 mg/day equivalent prednisolone). Patients withdrew in cases of ocular exacerbation.Results: A total of 21 patients were included (17 acute and 4 at-risk; mean duration of uveitis 45.6 ± 37.4 months). There were no serious adverse events related to gevokizumab. Recorded adverse events were mostly associated with exacerbation of uveitis or its complications. Response was evaluated for 14 acute patients and all showed rapid control of acute ocular exacerbation, mostly within 1 week, without any increase in corticosteroid dosage.Conclusions: Gevokizumab was well tolerated and rapidly controlled acute ocular exacerbations of Behçet's disease uveitis without the need for high-dose corticosteroid. [ABSTRACT FROM AUTHOR]

Purpose: To describe the demographics and clinical characteristics of anterior scleritis associated with uveitis in a referral center in Tunisia. Methods: The charts of twenty patients (20 eyes) diagnosed with sclero‐uveitis at Fattouma Bourguiba University Hospital, Monastir, Tunisia, presented between January 2015 and April 2022, were retrospectively reviewed. Detailed ophthalmic examination and fundus photography were performed in all patients. Mean follow‐up period was 28.4 months. Patients with keratitis or posterior scleritis were excluded. Results: There were eight women and 12 males patients with a mean age of 34.8 years. All patients presented with ocular pain. Mean initial best‐corrected visual acuity (BCVA) was 20/80 (range, 20/2000–20/25).There was an associated anterior uveitis in 80% of cases and panuveitis in 20%. Clinical findings at presentation included nodular scleritis in five eyes (25%) and scleromalacia perforans in four eyes (20%). Idiopathic sclero‐uveitis accounted for almost 55%. Identified causes of sclerouveitis included rheumatoid arthritis in four eyes (20%), tuberculosis in three eyes (15%), granulomatosis with polyangiitis in two eyes (10%), sarcoidosis in one eye (5%) and then one case after mRNA 1273 vaccine (5%). Ocular complications included pupillary seclusion in 25% of cases and vision loss in 10% of patients. Mean final BCVA was 20/100 (range, 20/4000–20/32). Treatment modalities of non‐infectious scleritis included indomethacine in 14 patients (82.3%), systemic corticosteroid in seven patients (41.1%) and immunosuppressant or biological agent in five patients (29.4%). Conclusions: Our results provide useful information about the patterns and etiologies of sclerouveitis. The leading causes of sclerouveitis include mainly rheumatoid arthritis and tuberculosis. An infectious cause should be always ruled out. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of Vogt‐Koyanagi‐Harada (VKH) disease following a serology‐confirmed bartonella henselae retinitis. Methods: A single case report. Results: A 41‐year‐old female patient presented with a central scotoma in her right eye (RE). Fundoscopic examination showed a focal retinitis with a macular star in the RE. Work‐up revealed positive bartonellosis serology. The patient was treated with oral azithromycine and oral steroids during 4 weeks with subsequent healing of the retinitis lesion. Three months after initial presentation, the patient complained of loss of vision in both eyes. Ophthalmological examination showed a best‐corrected visual acuity (BCVA) of 20/200 on both eyes, with a bilateral granulomatous panuveitis with bilateral multifocal exudative retinal detachment. Results of multimodal imaging were consistent with the diagnosis of acute VKH disease. Given the history of positive bartonellosis serology, the patient was treated with doxycycline (200 mg/day) for 6 weeks in association with intravenous methylprednisolone for 5 days followed by oral steroids and progressive tapering. At three‐month follow‐up, BCVA improved to 20/20 in both eyes associated with resolution of clinical and structural OCT changes. Conclusions: Our case suggests that bartonella henselae infection might be a non‐previously reported infectious trigger of VKH disease in genetically predisposed patients. Alternatively, bartonella henselae infection might manifest with panuveitis mimicking VKH disease. [ABSTRACT FROM AUTHOR]

Purpose: To compare clinical profile and visual outcomes of occlusive versus non‐occlusive retinal vasculitis (RV). Methods: A retrospective comparative study. Results: 284 patients were enrolled, including 124 patients with occlusive RV (ORV) and 160 patients with nonocclusive RV (NORV). Patients with ORV were older (p ≤ 10‐3), predominantly male (p ≤ 10‐3), with less bilateral involvement (31.5% vs. 53.4%; p ≤ 10‐3). Infectious RV was more frequently diagnosed in the ORV group than in the NORV group (48.8% vs. 32.9%, p = 0.006). Behçet disease and ocular tuberculosis were the leading causes of ORV. Idiopathic RV, Behçet disease, and sarcoidosis were the most common causes of NORV. Independent predictive factors of poor visual outcome were worse baseline visual acuity in both groups (p = 0.006 and p ≤ 10‐3, respectively), and retinal haemorrhages (p = 0.048) and optic atrophy (p = 0.040) in the ORV group. Conclusions: Occlusive and non‐occlusive RV have distinctive clinical and etiological profile. References 1. Agarwal A, Karkhur S, Aggarwal K, Invernizzi A, Singh R, Dogra MR, et al. Epidemiology and clinical features of inflammatory retinal vascular occlusions: pooled data from two tertiary‐referral institutions: Inflammatory retinal vascular occlusion. Clin Experiment Ophthalmol. janv 2018;46(1):62–74. 2. Mir TA, Reddy AK, Burkholder BM, Walsh J, Shifera AS, Khan IR, et al. Clinical Features and Incidence Rates of Ocular Complications in Patients With Retinal Vasculitis. Am J Ophthalmol. juill 2017;179:171–8. [ABSTRACT FROM AUTHOR]

Purpose: To describe restoration of outer retinal layers on Swept‐Source OCT (SS OCT) in Vogt Koyanagi Harada (VKH) disease over a year after the disease onset. Methods: Prospective longitudinal study carried out at the department of Ophthalmology of Fattouma Bourguiba University Hospital of Monastir. Twenty‐one patients (42 eyes) were followed‐up for 12 months after the disease onset. The patients were included at the acute phase and subsequently treated. Sequential SS OCT changes were assessed. Results: Structural SS OCT changes occurred in 24 eyes (57.1%) on month 3 (M3), in 23 eyes (54.8%) on month 6 (M6), and in 19 eyes (45.2%) on month 12 (M12). They included external nuclear layer atrophy (14.3% on M3; 11.9% on M6; and 9.5% on M12); ellipsoid zone disruption (40.5% on M3; 38.1% on M6; and 33.3% on M12); interdigitation zone disruption (42.9% on M3; 40.5% on M6; and 33.3% on M12); and multifocal retinal pigment epithelium thickening (50% on M3; 45.2% on M6; and 31% on M12). No significant association between final visual acuity and external retinal layers alterations at any stage of the study was found. Stepwise analysis showed that the presence of serous retinal detachment at presentation was an independent factor for structural SS OCT changes on M3. Conclusions: After initial onset, SS OCT shows thinning of the outer nuclear layer, disruption of the ellipsoid and interdigitation zones, and multifocal retinal pigment epithelium thickening. Serous retinal detachment at presentation is an independent factor for structural SS OCT changes during the first year of the disease. [ABSTRACT FROM AUTHOR]

Purpose: To compare clinical findings and visual outcomes of vitreous haemorrhage (VH) associated with inflammatory ocular conditions between children and adults patients. Methods: Retrospective study including 46 patients (56 eyes) diagnosed with VH associated with inflammatory ocular conditions in Department of ophthalmology, Fattouma Bourguiba university hospital, Tunisia. Demographics, clinical findings, etiologies, treatment modalities, and visual outcomes were compared between adults and children. Mean follow‐up period was 18 months. Results: There were 10 children (12 eyes) and 36 adults (44 eyes) patients. Mean age was 9.5 years in the children group (six males and four females) and 35 years in the adult group (26 males and 10 females). Comparative study showed that VH in the paediatric group was associated with a significantly lower presenting visual acuity, more frequently vitritis and fern‐like capillaritis, whereas VH in the adult group were more associated with vascular sheathing and retinal haemorrhages. The main mechanism of bleeding was inflammatory optic disc neovessels (NV) in the children group (66.6%, p ≤ 0.001) and ischemic posterior segment NV in the adult group (81.8%, p ≤ 0.001). Idiopathic intermediate uveitis (40%) was the leading cause of VH in the children group. However, tuberculosis (41.7%), Behçet's (19.4%) disease and sarcoidosis (11.1%) were the most common etiologies in the adult group. The mean final visual acuity was significantly higher in the paediatric group (20/25) than the adult group (20/50) (p = 0.045). Conclusions: Inflammatory VH has a distinctive clinical and etiological profile between children and adults. References 1. Agarwal A, Karkhur S, Aggarwal K, Invernizzi A, Singh R, Dogra MR, et al. Epidemiology and clinical features of inflammatory retinal vascular occlusions: pooled data from two tertiary‐referral institutions: Inflammatory retinal vascular occlusion. Clin Experiment Ophthalmol. janv 2018;46(1):62–74. 2. Mir TA, Reddy AK, Burkholder BM, Walsh J, Shifera AS, Khan IR, et al. Clinical Features and Incidence Rates of Ocular Complications in Patients With Retinal Vasculitis. Am J Ophthalmol. juill 2017;179:171–8. [ABSTRACT FROM AUTHOR]

Background: White dot syndromes (WDS) are a group of idiopathic multifocal inflammatory conditions that can be recognized and distinguished by lesion morphology, other specific clinical features, imaging findings, and disease course. Our purpose is to describe an atypical case of WDS with choriocapillaris ischemia shown by multimodal imaging including swept-source OCT angiography (OCTA) in a 30-year-old woman with latent tuberculosis.Findings: At presentation, visual acuity in the left eye was 20/500. Clinical findings included macular granularity, diffuse outer retinal discoloration with satellite yellow-white dots, and disc margin blurring. Fluorescein angiography showed early confluent areas of choroidal hypofluorescence and late perifoveal punctate hyperfluorescence. There was choroidal hypofluorescence in a geographic configuration throughout the indocyanine green angiography sequence. OCTA showed confluent geographic areas of loss of signal in the choriocapillaris. Work-up revealed latent tuberculosis. The patient received corticosteroids and prophylactic anti-tubercular treatment. Nine months later, visual acuity had improved to 20/20, and there were some residual retinal pigment epithelium changes.Conclusion: Atypical WDS associated with choriocapillaris hypoperfusion may show features of multiple evanescent white dot syndrome and acute posterior multifocal placoid pigment epitheliopathy melting together. [ABSTRACT FROM AUTHOR]