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Impressum
Acute posterior multifocal placoid pigment epitheliopathy - case report
Fryczkowski P., Kmera-Muszynska M., Prost M. G.
II Department of Ophthalmology, Medical Academy Warsaw, ul. Sierakowskiego 13, 03-709 Warsaw, Poland
Acute posterior multifocal placoid pigment epitheliopathy is a term first
used by Gass in 1968 to describe a syndrome characterized by: - rapid
decrease of visual acuity, secondary to flat, yellowish-white, placoid
lesions at the retinal pigment epithelium (RPE) level - spontaneous resolution
of these lesions with visual recovery, usually after few weeks, with permanent
discoloration in the pigment epithelium, without damage to the adjacent
retina and choroid.
Purpose: An atypical course of acute posterior multifocal placoid
epitheliopathy - case report.
Materials and methods: 59 year-old, diabetic man was seen at emergency
because of a few days history of blurred vision in his right eye. Ophtalmologic
examination revealed blurred margined, multiple, yellowish, placoid lesions,
¼ - 2 dd in the funduses of both eyes. We found pigment epithelium
detachments in a few bigger than ½ dd lesions There were also typical
for nonproliferative diabetic retinopathy lesions like microaneurysms,
dot and blot intraretinal hemorrhages and hard exudates. Optic discs,
macula, and blood vessels were normal. We found periferal drusen extending
from the equator to the ora serata in both eyes. During 8 months observation,
we performed ophtalmologic examination, fluorescein and indocyanine angiographies,
USG A and B, three times. No treatment was given.
Discussion: There is disagreement about the site of origin of the
placoid lesions, aetiology and pathogenesis in acute posterior multifocal
placoid epitheliopathy. In our report we agree with thesis that the choriocapillaris
is the primary site of break. We explain different diameters of lesions
via differencies between anatomical and functional lobules of the choroid.
No previous case of such longstanding lesions without changes has been
reported in the literature, the probable explanation is diabetic retinopathy
with its damaging effect on the capillaries course. Acute posterior multifocal
placoid epitheliopathy over 55th year of life has been described in two
cases.