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 clinically similar to acute posterior multifocal placoid pigment epitheliopathy (APMPPE) in older patients.


METHODS
We retrospectively reviewed medical records and photographic studies of consecutive patients over the age of 50 who presented to an academic tertiary care center with acute-onset visual symptoms associated with flat, gray-white lesions at the level of the retinal pigment epithelium reminiscent of APMPPE. Main outcome measures were visual acuity and macular anatomic status at the final follow-up visit.


RESULTS
The cohort included 4 men and 2 women with a median age of 72.5 (range, 58-82) years. The disease course was characterized by recurrent episodes in 6 of 11 eyes (55%), with initial or eventual bilaterality in all 5 binocular patients. Five of 6 patients were treated with corticosteroids, and all 6 patients experienced significant short-term improvement in visual acuity. However, 8 of 11 eyes (73%) 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 of 11 eyes (73%).


CONCLUSIONS
Although older patients presenting with APMPPE-like lesions are likely to experience visual improvement as acute lesions resolve, progression to geographic atrophy and choroidal neovascular membrane formation is the usual long-term outcome.
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; D018450:Disease Progression; D005260:Female; D005451:Fluorescein Angiography; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012164:Retinal Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D055213:Retinal Pigment Epithelium / Q000187:drug effects / Q000473:pathology*; D012189:Retrospective Studies; D013577:Syndrome; D014792:Visual Acuity / Q000502:physiology
D005938:Glucocorticoids; D007166:Immunosuppressive Agents