|Year : 1987 | Volume
| Issue : 2 | Page : 64-66
Acute posterior multifocal placoid pigment epitheliopathy
Eye Micro Surgery Centre, 2 Russell Street Calcutta-700 071, India
Eye Micro Surgery Centre, 2 Russell Street Calcutta-700 071
Source of Support: None, Conflict of Interest: None
4 Patients of APMPPE have been described and its probable pathogenesis discussed
|How to cite this article:|
Pahwa V. Acute posterior multifocal placoid pigment epitheliopathy. Indian J Ophthalmol 1987;35:64-6
This disease was first described by Gass in 1968. It is of an unknown etiology. However, it is postulated that there is a viral inflammation of the retinal pigmented epithelium (RPE) or choriocapilaries It is usually bilateral without any sex predilection. It may be preceded by an upper respiratory tract infection ,. Clinically there are multiple, yellow, circumscribed lesions at the level of the RPE in the postequatorial region involving the posterior pole. APMPPE has been reported in patients with Erythema nodosum and adenovirus type 5 infections. Elevated cerebrospinal fluid protein with pleocytosis has been documented in one patient
| Materials and Methods|| |
4 patients (all males) of APMPPE were seen in the year 1985. Their age ranged from 15-35 years. Sudden blurring of vision was noted by all these patients 3 of them had bilateral involvement Only one patient gave history of sore throat and moderate fever prior to the onset There was no history of hepatitis or gastroenteritis in the recent past General systemic examination did not reveal anything significant 3 mirror Goldmann examination and fluorescein angiography were done and pathological investigations including routine blood and urine examination were carried out.
| Observations|| |
Ocular examination revealed minimal signs of anterior uveitis with aqueous and vitreous flare, but keratic precipitates or posterior synechiae were not observed. Multiple small, yellowish, plaque like, sub-retinal lesions were seen in the fundus predominantly at the macula [Figure - 1]. These lesions were also found in the perimacular area and as far anteriorly as the equator. Some perivascular sheathing was seen around the dilated veins No retinal haemorrhages or exudates were seen The visual acuity of these eyes ranged from 6/9 to 6/24. In the fluorescein angiogram the yellow lesions blocked the choroidal fluorescence in the early phase [Figure - 2][Figure - 3] but showed late staining with the dye [Figure - 4][Figure - 5]. Blood and urine examination did not reveal anything significant
| Discussion|| |
In the early phase of the fluorescein angiogram these lesions do not fluoresce but obstruct background choroidal fluorescence [Figure - 2][Figure - 3].
Later in the angiogram, the placoid lesions stain with fluorescein [Figure - 4][Figure - 5] due to alteration in the integrity of the RPE which permits dye molecules to enter the cells It is thought that choriocapillaries rather than RPE is the primary site of inflammation . Choriocapillaries with capillary closure would explain the decreased choroidal fluorescence in the early angiogram Secondary involvement of RPE might then explain late hyperfluorescence. However clinicopathological correlation is still required to document the exact location of the inflammatory process No treatment was given to these patients Spontaneous resolution was seen in all of them and within a month their visual acuity improved. The placoid lesions disappeared and irregular pigment clumping was observed at the site of the lesions
| References|| |
Gass, J. D.M 1968, Arch. OphthalmoL 80: 177.
Ryan, S.J. and Maumenee, AE, 1972, Am J. Ophthalmol. 74: 1066.
Azar, P. Jr., Gohd, RS., Waltman, D. and Gitter, KA, 1975, Am J. Ophthalmol, 80:1003.
Fitzpatrick, P.J. and Robertson, D.M, 1973, Arch OphthalmoL 75: 334.
Krill, A E and Deutrnan, A F., 1972, Am J. Ophthalmol. 74: 193.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]
[Table - 1]