A syndrome resembling acute posterior multifocal placoid pigment epitheliopathy in older adults.
OBJECTIVE
To describe clinical characteristics and visual and anatomic outcomes of a syndrome in older patients that is similar in its active stage to acute posterior multifocal placoid pigment epitheliopathy, but has a distinct clinical course.


METHODS
We retrospectively reviewed medical records and photographic studies of consecutive patients over the age of 50 who presented with acute-onset visual symptoms associated with flat, gray-white lesions at the level of the retinal pigment epithelium reminiscent of acute posterior multifocal placoid pigment epitheliopathy.


RESULTS
The cohort included four men and two women with a median age of 72.5 (range, 58-82) years. The disease course was characterized by recurrent episodes in 6 (55%) of 11 eyes, with initial or eventual bilaterality in all five binocular patients. Five of six patients were treated with corticosteroids and all six patients experienced significant short-term improvement in visual acuity. However, 8 (73%) of 11 eyes developed progressive geographic atrophy and 7 (64%) developed choroidal neovascularization. With a mean (+/-SD) follow-up time of 6.6 +/- 5.5 years, the final visual acuity was 20/200 or worse in 8 (73%) of 11 eyes.


CONCLUSIONS
Although older patients presenting with acute posterior multifocal placoid pigment epitheliopathy-like lesions are likely to experience visual improvement as acute lesions resolve, geographic atrophy and choroidal neovascular membrane formation may subsequently develop, leading to moderate or severe visual loss.
Taich
Alexander
A
Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Johnson
Mark W
MW
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D020256:Choroidal Neovascularization / Q000175:diagnosis* / Q000188:drug therapy; D018450:Disease Progression; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012164:Retinal Diseases / Q000175:diagnosis* / Q000188:drug therapy; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D012189:Retrospective Studies; D012607:Scotoma / Q000175:diagnosis* / Q000188:drug therapy; D013577:Syndrome; D014792:Visual Acuity / Q000502:physiology
D005938:Glucocorticoids