Application of OCT-angiography to characterise the evolution of chorioretinal lesions in acute posterior multifocal placoid pigment epitheliopathy

PurposeThe aim of this study was to determine a sequence of structural changes in acute posterior multifocal placoid pigment epitheliopathy (APMPPE) using optical coherence tomography-angiography (OCT-A) and comparing with other imaging modalities.Patients and methodsPatients with a new diagnosis of...

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Bibliographic Details
Published in:Eye (London) 2017-10, Vol.31 (10), p.1399-1408
Main Authors: Burke, T R, Chu, C J, Salvatore, S, Bailey, C, Dick, A D, Lee, R W J, Ross, A H, Carreño, E
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Angiography
Choroiditis - diagnosis
Choroiditis - physiopathology
Clinical Study
Disease Progression
Epithelium
Female
Fluorescein
Fluorescein Angiography - methods
Follow-Up Studies
Fundus Oculi
Humans
Ischemia
Macula Lutea - pathology
Male
Medical imaging
Multifocal Choroiditis
Multimodal Imaging
Posterior Eye Segment - pathology
Reproducibility of Results
Retina
Retinal pigment epithelium
Retinal Pigment Epithelium - pathology
Retrospective Studies
Tomography, Optical Coherence - methods
Visual Acuity
Young Adult
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Summary:PurposeThe aim of this study was to determine a sequence of structural changes in acute posterior multifocal placoid pigment epitheliopathy (APMPPE) using optical coherence tomography-angiography (OCT-A) and comparing with other imaging modalities.Patients and methodsPatients with a new diagnosis of acute-onset APMPPE referred to a regional specialist centre from October 2015 to October 2016 were included. Multimodal imaging employed on all patients from diagnosis included the following: fundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence, spectral domain-OCT (SD-OCT), and OCT-A. All non-invasive imaging processes were repeated during follow-up.ResultsTen eyes of five patients were included in the study, three males and two females, with a mean age of 26.2 years (range: 21-32) and a mean follow-up of 6.4 months (range: 2.6-13.3). All patients presented with bilateral disease and macular involving lesions. OCT-A imaging of the choriocapillaris was supportive of hypoperfusion at the site of APMPPE lesions during the acute phase of this condition with normalisation of choroidal vasculature during follow-up. Multimodal imaging consistently highlighted four sequential phases from presentation to resolution of active disease.ConclusionsMultimodal imaging in patients with APMPPE in acute and long-term follow-up demonstrates a reversible choroidal hypoperfusion supporting the primary inciting pathology as a choriocapillaritis. The evolution shows resolution of the ischaemia through a defined sequence that results in persistent changes at the level of the retinal pigment epithelium and outer retina. OCT-A was able to detect preclinical changes and chart resolution at the level of the choriocapillaris.
ISSN:0950-222X
1476-5454
DOI:10.1038/eye.2017.180