APMPPE

Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) is a rare, self-limiting inflammatory condition that affects the retina and the retinal pigment epithelium (RPE). It is characterized by the sudden onset of multiple, yellow-white placoid lesions at the level of the RPE, which can lead to visual disturbances.

Presentation

Patients with APMPPE typically present with sudden, painless loss of vision in one or both eyes. The visual loss can range from mild to severe and is often associated with scotomas (blind spots) in the visual field. Other symptoms may include photopsia (flashes of light) and metamorphopsia (distorted vision).

Pathophysiology

The exact cause of APMPPE is unknown, but it is believed to be an inflammatory process that affects the choriocapillaris, leading to ischemia and subsequent damage to the RPE and outer retina. The condition is often preceded by a flu-like illness, suggesting a possible viral or autoimmune etiology.

Diagnosis

Diagnosis of APMPPE is primarily clinical, based on the characteristic appearance of the lesions on fundus examination. Ancillary tests such as fluorescein angiography and indocyanine green angiography can help confirm the diagnosis by showing early hypofluorescence and late hyperfluorescence of the lesions. Optical coherence tomography (OCT) can also be useful in assessing the extent of retinal involvement.

Treatment

There is no specific treatment for APMPPE, and the condition is usually self-limiting, with most patients experiencing spontaneous improvement in vision over weeks to months. In some cases, corticosteroids may be used to reduce inflammation and speed up recovery, especially in patients with severe or bilateral involvement.

Prognosis

The prognosis for APMPPE is generally good, with most patients recovering their vision. However, some patients may have residual visual deficits, such as persistent scotomas or mild visual acuity loss. Recurrences are rare but can occur.

Related Conditions

APMPPE is part of a spectrum of inflammatory retinal diseases that includes Serpiginous choroiditis, Multiple evanescent white dot syndrome (MEWDS), and Birdshot chorioretinopathy.

See Also

• Retina
• Retinal pigment epithelium
• Fluorescein angiography
• Optical coherence tomography
• Serpiginous choroiditis
• Multiple evanescent white dot syndrome
• Birdshot chorioretinopathy