June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
New staging of Acute Posterior Multifocal Placoid Pigment Epiteliopathy by using multimodal imaging
Author Affiliations & Notes
  • Ester Carreno
    Bristol Eye Hospital, Bristol, United Kingdom
  • Tomas Burke
    Bristol Eye Hospital, Bristol, United Kingdom
  • Colin Chu
    School of Clinical Sciences, Faculty of Medicine and Dentistry, University of Bristol, Bristol, United Kingdom
    Bristol Eye Hospital, Bristol, United Kingdom
  • Serena Salvatore
    Bristol Eye Hospital, Bristol, United Kingdom
  • Richard W J Lee
    School of Clinical Sciences, Faculty of Medicine and Dentistry, University of Bristol, Bristol, United Kingdom
    Bristol Eye Hospital, Bristol, United Kingdom
  • Clare Bailey
    Bristol Eye Hospital, Bristol, United Kingdom
  • Andrew D Dick
    Bristol Eye Hospital, Bristol, United Kingdom
    School of Clinical Sciences, Faculty of Medicine and Dentistry, University of Bristol, Bristol, United Kingdom
  • Adam H Ross
    Bristol Eye Hospital, Bristol, United Kingdom
  • Footnotes
    Commercial Relationships   Ester Carreno, None; Tomas Burke, None; Colin Chu, None; Serena Salvatore, None; Richard Lee, None; Clare Bailey, None; Andrew Dick, None; Adam Ross, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 5995. doi:
  • Views
  • Share
  • Tools
    • Alerts
      ×
      This feature is available to Subscribers Only
      Sign In or Create an Account ×
    • Get Citation

      Ester Carreno, Tomas Burke, Colin Chu, Serena Salvatore, Richard W J Lee, Clare Bailey, Andrew D Dick, Adam H Ross; New staging of Acute Posterior Multifocal Placoid Pigment Epiteliopathy by using multimodal imaging. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5995.

      Download citation file:


      © ARVO (1962-2015); The Authors (2016-present)

      ×
  • Supplements
Abstract

Purpose : Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a rare disease involving the choriocapillaris, retinal pigment epithelium and retina. Although the pathoaetiology remains unknown, inflammation of the choriocapillaris is the likely primary insult. The aim of this study by using multimodal imaging was to determine a sequence of structural changes during evolution and course of APMPPE.

Methods : All patients with a new diagnosis and acute presentation of APMPPE seen at our regional care centre from October 2015 to October 2016 were included. Multimodal imaging employed on all patients from diagnosis included: fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), fundus autofluorescence (FAF), spectral domain-optical coherence tomography (SD-OCT) and OCT-Angiography (OCT-A). Non-invasive imaging was repeated during follow-up.

Results : Five patients were included in the study, 3 males and 2 females, with a mean age of 26.2 (range: 21-32) years and a mean follow-up of 4.69 (range: 2.3-10.3) months. All patients presented with bilateral disease and macular involving lesions, accompanied by significant headache and a viral-prodrome prior to presentation. Multimodal imaging has consistently highlighted 4 sequential stages during APMPPE (see legend).

Conclusions : The use of multimodal imaging for the follow-up of patients with APMPPE supports the increasing evidence of a choriocapillaritis. The evolution shows resolution of ischaemia but a defined sequence that results in permanent changes at the level of the retinal pigment epithelium (RPE).

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

Multimodal imaging in APMPPE was able to define 4 stages. Stage 1: Choriocapillaris hypoperfusion disclosed through OCT-A and confirmed with ICGA and early FFA phenotype. Stage 2: Evidence of classic active lesion on the FFA with early hypofluorescence and late hyperfluorescence, persistent hypocyanescence lesion through ICGA frames, hypoperfusion on the OCT-A and disorganisation and hypereflectivity of the outer retinal layers on the SD-OCT. Stage 3: Thinning and disruption of outer retinal layers on the SD-OCT, but persistent ischemia of the choriocapillaris on the OCT-A. Stage 4: Remaining retinal thinning in the SD-OCT at the lever of outer retina with hyporeflectivity at the RPE and hypoautofluorescent lesions, but normalised choriocapillaris on the OCT-A.

Multimodal imaging in APMPPE was able to define 4 stages. Stage 1: Choriocapillaris hypoperfusion disclosed through OCT-A and confirmed with ICGA and early FFA phenotype. Stage 2: Evidence of classic active lesion on the FFA with early hypofluorescence and late hyperfluorescence, persistent hypocyanescence lesion through ICGA frames, hypoperfusion on the OCT-A and disorganisation and hypereflectivity of the outer retinal layers on the SD-OCT. Stage 3: Thinning and disruption of outer retinal layers on the SD-OCT, but persistent ischemia of the choriocapillaris on the OCT-A. Stage 4: Remaining retinal thinning in the SD-OCT at the lever of outer retina with hyporeflectivity at the RPE and hypoautofluorescent lesions, but normalised choriocapillaris on the OCT-A.

×
×

This PDF is available to Subscribers Only

Sign in or purchase a subscription to access this content. ×

You must be signed into an individual account to use this feature.

×