Progression of Choroidal Atrophy in Acute Posterior Multifocal Placoid Pigment Epitheliopathy

Daniele, Salvatore; Daniele, C.; Orcidi, Fabrizio; Tavano, Antonio

doi:10.1159/000027264

Cited by 7 publications

(4 citation statements)

References 20 publications

(19 reference statements)

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“…They also presented one of the following atypical features: age older than 60 years, unilaterality, an interval before involvement of the second eye of at least 6 months, and recurrence of the disease [18]. In rare cases, typical signs are also associated with progressive deterioration, with widespread severe choroidal atrophy after apparent clinical healing of the placoid lesions [19].…”

Section: Discussionmentioning

confidence: 99%

Management of Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE): Insights from Multimodal Imaging with OCTA

Oliveira

Simão

Martins

et al. 2020

Case Reports in Ophthalmological Medicine

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A 28-year-old man presented to the emergency room with blurred vision in the right eye for two days. He reported a preceding flu-like illness one week earlier. His best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/25 in the left eye. There was no anterior chamber inflammation or vitritis in either eye. He presented multiple yellowish-white placoid lesions in the posterior pole, some involving the foveal area, bilaterally. General examination and systemic investigation were unremarkable. Multimodal evaluation with fluorescein angiography, indocyanine green angiography, and spectral domain and optical coherence tomography angiography (OCTA) were consistent with the diagnosis of acute posterior multifocal placoid pigment epitheliopathy. Due to centromacular involvement with decreased BCVA, treatment with oral methylprednisolone was started after infectious causes were ruled out. After two weeks, the patient presented functional and anatomical improvement. OCTA showed partial reperfusion of the choriocapillaris in the affected areas, in both eyes.

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Section: Discussionmentioning

confidence: 99%

Management of Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE): Insights from Multimodal Imaging with OCTA

Oliveira

Simão

Martins

et al. 2020

Case Reports in Ophthalmological Medicine

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“…Deutman's thesis of hypo-or non-perfusion was confirmed when ICGA became available, with an article published in 1995 [57]. As far as severity of lesions is concerned, APMPPE/AMIC seems to be in the middle range of the PICCP spectrum, as some cases can resolve without treatment while in others severe non-perfusion renders systemic corticosteroids and/or non-steroidal immunosuppression necessary [58][59][60]. Inflammatory occlusion affects larger choriocapillaris vessels, and, compared to MEWDS, the areas of non-perfusion are more widespread and confluent.…”

Section: Apmppementioning

confidence: 97%

“…In our experience, however, many cases presented with extensive lesions and marked visual impairment and had to be treated with systemic corticosteroids, which seems to be sufficient as the insult is limited in time. We rarely had to resort to additional non-steroidal immunosuppression [58][59][60]63]. One complication or co-morbidity that the clinician should be aware of is cerebral vasculitis and in case of neurological symptoms, a cerebral angio-MRI should be performed [64,65].…”

Section: Apmppementioning

confidence: 99%

Diagnosis and Treatment of Primary Inflammatory Choriocapillaropathies (PICCPs): A Comprehensive Overview

Papasavvas¹,

Herbort²

2022

Medicina

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Purpose: Primary inflammatory choriocapillaropathies (PICCPs) belong to a group of intraocular inflammatory diseases with the common characteristic of inflammatory choriocapillaris hypo- or non-perfusion as the main clinicopathological mechanism. The purpose of our article is to describe clinical characteristics and multimodal imaging, that can help the diagnosis and treatment of PICCPs. Methods: Narrative review with multimodal imaging analysis. Results: Choriocapillaris non-perfusion can affect the end-choriocappilaries, at the benign end of the PICCP spectrum (MEWDS), to larger choriocapillaris vessels or precapillary vessels at the origin of more severe forms such as acute posterior multifocal placoid pigment epitheliopathy (APMPPE), idiopathic multifocal choroiditis (MFC) and Serpiginous Choroiditis (SC). Diagnosis is mostly based on multimodal imaging and especially on indocyanine green angiography (ICGA), fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT)/OCT-angiography (OCT-A). ICGA shows the typical pattern of patchy lobular hypofluorescence reflecting hypo- or non-perfusion of the choriocapillaris that can also take the aspect of geographic areas in the more severe forms. Treatment depends on the severity of the disease and goes from observation in MEWDS and some mild cases of APMPPE, to oral corticosteroid and/or immunomodulator agents in the more severe conditions of APMPPE and MFC and SC cases. Close multimodal monitoring is crucial in order to introduce or adjust treatment. Conclusion: PICCPs are resulting from one common clinicopathological mechanism, inflammatory choriocapillaris hypo- or non-perfusion. ICGA findings are essential for the diagnosis and follow-up of PICCPs, but non-invasive methods such as FAF and SD-OCT/OCT-A also have their role especially in follow-up of the diseases. Treatment should be individualized according to the pathology and the evolution of lesions.

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“…Generally, AMPPPE has a good long-term prognosis for VA, although most patients have residual symptoms and paracentral scotomas [56]. Seldom, AMPPPE can lead to a severe loss of vision due to atrophic macular changes, subretinal fibrosis and CNV [57][58][59][60]. More specifically, CNV is a very rare complication of AMPPPE [61,62].…”

Section: Acute Multifocal Posterior Placoid Pigment Epitheliopathymentioning

confidence: 99%

Antivascular Endothelial Growth Factors for Inflammatory Chorioretinal Disorders

Parodi

Iacono

Verbraak³

et al. 2010

Anti-Vegf

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Macular edema (ME) and choroidal neovascularization (CNV) can complicate the course of several inflammatory chorioretinal diseases, leading to a severe visual function impairment. The most frequently involved clinical entities include for example multifocal choroiditis, presumed ocular histoplasmosis syndrome, Beçhet's disease, multiple evanescent white dot syndrome, birdshot chorioretinopathy, acute multifocal posterior placoid pigment epitheliopathy, serpiginous choroiditis, and persistent placoid maculopathy. Results that have reported on antivascular endothelial growth factor (anti-VEGF) treatment in uveitic patients with CNV or ME have demonstrated positive results in many cases. However, bearing in mind that it has been proven impossible to perform randomized clinical trials with anti-VEGF in uveitic patients with CNV or ME, further studies with longer follow-ups are necessary to assess the value of this therapeutic approach.

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Progression of Choroidal Atrophy in Acute Posterior Multifocal Placoid Pigment Epitheliopathy

Cited by 7 publications

References 20 publications

Management of Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE): Insights from Multimodal Imaging with OCTA

Management of Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE): Insights from Multimodal Imaging with OCTA

Diagnosis and Treatment of Primary Inflammatory Choriocapillaropathies (PICCPs): A Comprehensive Overview

Antivascular Endothelial Growth Factors for Inflammatory Chorioretinal Disorders

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