Indocyanine green angiography in acute posterior multifocal placoid pigment epithelial disease

Abstract

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is an idiopathic posterior segment inflammatory disorder of young adults. The pathogenesis remains unsettled. The placoid lesions and characteristic findings on fluorescein angiography have been interpreted as representing a primary pigment epithelial disorder or a choroidal vascular disease. Using Fluorescein and Indocyanine green angiography we examined one patient with APMPPE. In the acute phase, the fluorescein angiogram showed early hypofluorescence of the ophthalmoscopically visible lesions followed by late hyperfluorescence with centripetal staining of fluorescein at the level of the pigment epithelium. Indocyanine green angiograms showed in the acute stage of this disease areas of hypofluorescence in both the early and late pictures that nearly correlated with the placoid lesions. Three weeks later we saw apart from involution of the initial lesions, new angiographic hypofluorescent lesions at the posterior pole of the left eye, which were ophthalmoscopically not visible. During the next four weeks the older and newer lesions went smaller and left scars. Also the choroidal blood flow was restored partially. Indocyanine green choroidal videoangiography has shown hypofluorescence of the placoid lesions. This may be explained by choroidal hypoperfusion as the pathogenesis of acute posterior multifocal placoid pigment epitheliopathy.