June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Ellipsoid Zone Area as a Marker for Recovery in Patients with Acute Posterior Multifocal Placoid Pigmented Epitheliopathy Treated with Oral Steroids
Author Affiliations & Notes
  • Andrew Browne
    Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Waseem Ansari
    Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Kimberly Baynes
    Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Careen Lowder
    Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Sunil K Srivastava
    Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, United States
  • Footnotes
    Commercial Relationships   Andrew Browne, None; Waseem Ansari, None; Kimberly Baynes, None; Careen Lowder, None; Sunil Srivastava, None
  • Footnotes
    Support  This study was supported in part by the NIH-NEI P30 Core Grant (IP30EY025585-01A1) and Unrestricted Grant from The Research to Prevent Blindness, Inc., awarded to the Cole Eye Institute.
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 1300. doi:
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      Andrew Browne, Waseem Ansari, Kimberly Baynes, Careen Lowder, Sunil K Srivastava; Ellipsoid Zone Area as a Marker for Recovery in Patients with Acute Posterior Multifocal Placoid Pigmented Epitheliopathy Treated with Oral Steroids. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1300.

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

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Abstract

Purpose : Acute posterior multifocal placoid pigmented epitheliopathy (APMPPE) is a believed to be a self-limited inflammatory vasculopathy affecting the choriocapillaris and resulting in outer retinal ischemia. We sought to evaluate the recovery of normal outer retinal architecture in patients presenting acutely or subacutely with visual changes and diagnosis of APMPPE confirmed by exam and angiographic imaging. We measure the rate of visual acuity and ellipsoid zone recovery on optical coherence tomography (OCT) after initiating systemic steroids in patients with APMPPE.

Methods : A retrospective review of medical records was performed for cases of APMPPE treated with systemic steroids. Six patients (12 eyes) were included based on typical fundus appearance, fluorescein angiography, unambiguous presentation history and negative laboratory evaluation. Visual acuity was measured and the status of pigment changes was documented before and after treatment. Manual grading of area of normal ellipsoid zone was performed by two graders and quantified using OCT viewer software.

Results : Eleven out of 12 eyes demonstrated ellipsoid zone recovery after initiation of steroids. Rate of recovery did not demonstrate a relationship to active use of steroid. All eyes except one demonstrated improvement in visual acuity, and this one eye was the only eye to demonstrate no improvement in ellipsoid zone area. All eyes demonstrated symptomatic improvement in vision.

Conclusions : Treatment of APMPPE with prednisone may expedite resolution of choriocapillaris inflammation, but the recovery of ellipsoid zone persists well after the treatment period with steroids. Anatomical endpoints such as ellipsoid zone area serve as surrogates for recovery from acute insult to the outer retina presumed to be secondary choriocapillaris inflammation and other disease processes.

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

 

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