Phase-Variance Optical Coherence Tomographic Angiography Imaging of Choroidal Perfusion Changes Associated With Acute Posterior Multifocal Placoid Pigment Epitheliopathy.

Letters OBSERVATION Phase-Variance Optical Coherence Tomographic Angiography Imaging of Choroidal Perfusion Changes Associated With Acute Posterior Multifocal Placoid Pigment Epitheliopathy Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is characterized by bilateral multiple placoid white-gray lesions of the posterior pole at the level of the retinal pigment epithelium (RPE) and/or choriocapillaris, which self-resolve with recovery of vision. 1,2 The etiology is unknown, but APMPPE has been associated with viral pro- dromes and vasculitis. The placoid lesions are thought to represent focal RPE inflammation or choriocapillaris ische- mia based on fluorescein angiogram findings of early hypo- fluorescence and late hyperfluorescence. Phase-variance optical coherence tomographic angiogra- phy (pv-OCTA) allows noninvasive visualization of the cho- roidal blood flow in 3 dimensions in vivo. 3,4 A custom-built OCT system (125-kHz line rate, 855-nm central wavelength, and 4.5-μm axial resolution) was used to image choroidal perfu- sion over a 1.5 × 1.5-mm 2 area (equally spaced 350 A-scans in both x- and y-axes) in acute APMPPE. Report of a Case | A woman in her mid to late 20s with viral pro- drome presented with blurry vision in the left eye for 1 week. Visual acuity was 20/20 OD and 20/400 OS. The right eye was normal, and the left eye had normal anterior segment and vit- reous, but fundus showed multiple white-gray placoid lesions posteriorly with early hypofluorescence and late hyperfluores- cence on fluorescein angiogram (Figure 1). Patchy hypoperfu- sion of the choriocapillaris and Sattler layer was noted on pv-OCTA corresponding to focal areas of photoreceptor and RPE irregularity on OCT B-scans (Figure 2A-C). Serology test results were negative for syphilis, sarcoidosis, and tuberculosis. After 2 weeks, similar placoid lesions were noted in the right eye. After 6 weeks, placoid lesions resolved bilaterally to de- velop pigment clumping (Figure 1D) and choroidal perfusion mostly normalized on pv-OCTA. Visual acuity and photorecep- tor irregularity on OCT minimally improved (Figure 2D-F). By the 6-month follow-up, visual acuity was 20/20 OD and 20/30 OS, with almost normalized photoreceptor layer on OCT (Figure 2G). This study conforms to the World Medical Association Dec- laration of Helsinki 5 and subsequent amendments. The re- search protocol was approved by the University of California, Davis Office of Human Research. Figure 1. Fundus Photograph and Fluorescein Angiogram of the Left Eye A White-gray placoid lesions D Changes at 6 wk B C Early hypofluorescence E Late hyperfluorescence Changes at 6 wk At presentation, white-gray placoid lesions are seen (A), with early hypofluorescence (B) and late hyperfluorescence (C) on angiography; pigmentary changes developed by 6 weeks’ follow-up (D and E). jamaophthalmology.com (Reprinted) JAMA Ophthalmology August 2016 Volume 134, Number 8 Copyright 2016 American Medical Association. All rights reserved. Downloaded From: http://archopht.jamanetwork.com/ by a University of California - Davis User on 09/13/2016