Epitheliopathy, acute posterior multifocal placoid

Epitheliopathy, Acute Posterior Multifocal Placoid (APMPPE) is a rare eye condition that affects the retina, specifically the retinal pigment epithelium and the choroid. It is characterized by the sudden onset of multiple, small, white or yellowish-white lesions in the deep retina, at the level of the retinal pigment epithelium. These lesions typically appear in both eyes, although they may not develop simultaneously. The condition is often preceded by a viral-like illness and is thought to be an immune-mediated response.

Symptoms

The primary symptoms of APMPPE include sudden and usually temporary loss of vision, which may be accompanied by flashes of light and floaters. The severity of vision loss can vary widely among individuals, from mild to severe. Other symptoms may include photopsia (flashes of light) and scotoma (areas of decreased or lost vision in the visual field). The symptoms typically resolve over a period of weeks to months, but some individuals may experience residual visual impairment.

Causes

The exact cause of APMPPE is unknown, but it is believed to be related to an autoimmune response following a viral infection. This condition is thought to involve an inflammatory response that affects the blood vessels supplying the retina, leading to the characteristic lesions.

Diagnosis

Diagnosis of APMPPE is primarily based on the clinical presentation and findings from imaging studies. Fluorescein angiography is a key diagnostic tool that can reveal early hypofluorescence of the lesions followed by late staining. Optical coherence tomography (OCT) can also be useful in visualizing the structural changes in the retina and retinal pigment epithelium. In some cases, additional tests may be performed to rule out other conditions that can present with similar symptoms.

Treatment

There is no specific treatment for APMPPE, as the condition is usually self-limiting and tends to resolve on its own. However, in cases where severe vision loss occurs or there is evidence of significant inflammation, treatment with corticosteroids may be considered to reduce inflammation and improve visual outcomes. It is important for individuals with APMPPE to undergo regular follow-up with an ophthalmologist to monitor the resolution of lesions and to manage any complications that may arise.

Prognosis

The prognosis for individuals with APMPPE is generally good, with most patients experiencing a significant improvement in vision over time. However, some individuals may have persistent visual field defects or other visual impairments. Early detection and management of any complications can help improve the long-term visual prognosis.