ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY ON OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.
OBJECTIVE
To investigate choroidal involvement in acute posterior multifocal placoid pigment epitheliopathy (APMPPE).


METHODS
A retrospective observational case series using multimodal imaging including optical coherence tomography (OCT) angiography.


RESULTS
Five patients with APMPPE were included. In most acute lesions, OCT angiography revealed outer retinal and retinal pigment epithelium (RPE) hyperreflective lesions with attenuated OCT signal in the underlying choroid, but careful examination allowed us to identify a single lesion with decreased choriocapillaris flow outside the signal attenuation. Optical coherence tomography angiography obtained after healing of lesions revealed areas of hypointense circular flow voids clustered in groups surrounded by either isointense or hyperintense signal background. Point-by-point evaluation revealed these flow voids did not correspond to areas of RPE thickening or focal pigmentary changes. Larger hypointense lesions were observed and did correlate with pigmentary changes.


CONCLUSIONS
Our case series demonstrates choriocapillaris flow abnormalities in acute APMPPE extending beyond the OCT lesions, and distinct residual vascular abnormalities in healed APMPPE lesions on OCT angiography. Our findings support a primary ischemic insult to the photoreceptors and RPE, but choriocapillaris flow abnormalities could be secondary to (OCT invisible) retinal and RPE involvement. The lack of understanding of the etiology along with the inability to visualize most of the choroid in acute lesions precludes definite conclusions about the true pathogenesis of APMPPE.
*Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and †Department of Ophthalmology, Schepens Eye Research Institute/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.
Michael J
MJ
Heiferman
Safa
S
Rahmani
Lee M
LM
Jampol
Peter L
PL
Nesper
Dimitra
D
Skondra
Leo A
LA
Kim
Amani A
AA
Fawzi
D000208:Acute Disease; D000328:Adult; D002829:Choroid / Q000098:blood supply; D002833:Choroiditis / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D000080364:Multifocal Choroiditis; D010857:Pigment Epithelium of Eye / Q000473:pathology*; D041623:Tomography, Optical Coherence / Q000379:methods*; D014792:Visual Acuity; D055815:Young Adult