Purpose

To 1) describe an unusual presentation of unilateral Acute Posterior Multifocal Placoid Pigment Epitheliopathy APMPPE with subretinal fluid (SRF) and 2) add to the database of other case studies which describe similar findings, not commonly reported in APMPEE literature.

Methods

Consent was gained from a 53 year-old male patient presenting with sudden painless unilateral drop in vision and central scotoma to Royal Bolton Eye Hospital. Multimodal imaging was gathered and interpreted including fundus fluorescein angiography (FFA), indocyanine green angiography (ICG), spectral domain optical coherence tomography (OCT), OCT angiography (OCTA), and fundus autofluorescence (figures to be attached to poster). Imaging was repeated every 2 days in the first week to monitor progression closely.

Results

Apart from his presenting symptoms, the patient was otherwise systemically well with no past medical history. A full workup for uveitis was inconclusive. Multimodal imaging confirmed presence of both intraretinal fluid (IRF) and SRF at initial presentation. FFA revealed hypofluorescence in the early phase with irregular hyperfluorescence of lesions in the late frames. ICGA exhibited hypocyanescence of the said lesions. Subsequent imaging showed rapid resolution of IRF and SRF which correlated well with his resolving symptoms in the first week without treatment. Oral steroids were thereafter commenced to hasten the visual recovery further.

Conclusions

APMPEE is an uncommon self-limiting inflammatory chorioretinopathy described as a subset of the white dot syndromes. It is usually bilateral but can present atypically as unilateral with SRF, as in this case. Although SRF is an uncommon finding in APMPPE, it’s presence should not lower threshold of diagnosis.