Pigment Epithelium Detachment in Severe Acute Posterior Multifocal Placoid Pigment Epitheliopathy

Summary

PED in severe APMPPE is associated with worse initial VA, bacillary layer detachment, and serous RD. PED biomarker for severe disease and choriocapillaris ischemia — Retrospective, 46 eyes

Abstract

Purpose: To describe the spectrum of optical coherence tomography (OCT) findings in acute posterior multifocal placoid pigment epitheliopathy (APMPPE), with a specific focus on the prevalence of pigment epithelium detachments (PEDs).

Methods: Multicenter, retrospective, longitudinal study including patients diagnosed with APMPPE based on color fundus photography, OCT, and fluorescein angiography. Demographics, visual acuity, and the following OCT findings were assessed: outer retinal hyperreflectivity, serous retinal detachment (SRD), bacillary layer detachment (BALAD), and PED.

Results: Forty-six eyes of 27 patients were included. The median age at presentation was 23 years (range: 18-36 years), and 17 patients (62.9%) were men. At baseline, outer retinal hyperreflectivity was found in all eyes, while BALAD, SRD, and PED were observed in 22 (47.8%), 14 (30.4%), and 26 eyes (56.5%), respectively. A univariate logistic regression showed a significant association between the presence of PED and a worse baseline visual acuity (odds ratio [OR]: 5.3; 95% confidence interval [CI]: 1.5-18.6; P = 0.01), the presence of BALAD (OR: 9.0; 95% CI: 2.3-35.6; P = 0.002), and the presence of SRD (OR: 7.3; 95% CI: 1.4-38.3; P = 0.02).

Conclusion: PEDs were significantly associated with a poorer initial visual acuity, as well as with the presence of BALAD and SRD on presentation. These findings suggest that PEDs could be used as a biomarker of disease severity and choriocapillaris ischemia in APMPPE.