title: Retinal fluorescein and indocyanine green angiography and spectral-domain optical coherence tomography findings in acute retinal pigment epitheliitis.
abstract: OBJECTIVE
  To determine the specific location of the initial lesion in acute retinal pigment epitheliitis.
  
  
  METHODS
  Four patients diagnosed with acute retinal pigment epitheliitis were studied. Fundus photographs, fluorescein angiography and indocyanine green angiography, and spectral-domain optical coherence tomography findings were reviewed.
  
  
  RESULTS
  Four healthy young patients presented with acute onset of unilateral decreased vision. Ophthalmoscopy showed macular pigment mottling with surrounding yellow hypopigmented areas at the level of the retinal pigment epithelium (RPE). Fluorescein angiography revealed transmission hyperfluorescence. Early-phase and midphase indocyanine green angiography images showed a patchy macular hyperfluorescence. At late phase of indocyanine green angiography, a hyperfluorescent halo with a cockadelike appearance of the macular area was observed. Spectral-domain optical coherence tomography showed a disruption of the photoreceptors' inner segment and outer segment interface associated with a wider disruption of the RPE inner band. These disrupted lines were replaced by a dome-shaped highly reflective lesion involving the RPE inner layer, the photoreceptors' inner segment and outer segment layers, and, in two cases, the outer nuclear layer. With time, indocyanine green angiography showed resolution of the observed lesions. Spectral-domain optical coherence tomography showed restored and continuous inner segment and outer segment layers and RPE inner band.
  
  
  CONCLUSIONS
  Spectral-domain optical coherence tomography findings suggest that the initial lesion in acute retinal pigment epitheliitis is located at the junction between the photoreceptor outer segments and the apical side of the RPE cells. Indocyanine green angiography and spectral-domain optical coherence tomography show that the RPE appears to be more widely involved than the neurosensory retina.
authors.affiliation: Department of Ophthalmology, Saint-Roch University Hospital, Nice, France. a.rothova@umcutrecht.nl
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Baillif
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wolff
authors.forename: Vincent
authors.initials: V
authors.lastname: Paoli
authors.forename: Pierre
authors.initials: P
authors.lastname: Gastaud
authors.forename: Martine
authors.initials: M
authors.lastname: Mauget-Faÿsse
mesh_terms: D000208:Acute Disease; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D012173:Retinitis / Q000175:diagnosis* / Q000503:physiopathology; D012607:Scotoma / Q000175:diagnosis / Q000503:physiopathology; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green