Reconstitution of the Choriocapillaris in Acute Posterior Multifocal Placoid Pigment Epitheliopathy.

Abstract

To describe findings derived from extensions of optical coherence tomography, including volume rendering and frame averaged OCT angiography (OCT-A), in a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE). Case report of a patient with APMPPE imaged during the acute and convalescent stages. A 20-year-old male presented with an acute change in vision. He had multiple yellow-white placoid lesions at the level of the retinal pigment epithelium (RPE) in the macula and nasal to the optic nerve in both eyes. Within 2 weeks, his visual acuity worsened to 20/80 and 20/400 in the right and left eyes, respectively. SD-OCT showed focal defects in the ellipsoid and RPE layers. Volume rendering OCT-A showed inflammatory cells in the outer nuclear layer (ONL) above the APMPPE lesion. Frame averaged OCT-A revealed significant loss of capillary flow signal within capillary segments of the choriocapillaris. Ten weeks after presentation, there was resolution of the placoid changes, discontinuance of the inflammatory infiltrate in the ONL, and significant reconstitution of flow in the choriocapillaris. The visual acuity was 20/20 in both eyes. Novel volume rendered and frame averaged OCT-A images in a patient with APMPPE allowed detection of inflammatory cell infiltrate in the ONL as well as reversible capillary segment non-perfusion of associated APMPPE lesions. The findings suggest short term insults to choriocapillaris function may be reversible and can be tracked with modern imaging techniques.