OCT Angiography in Acute Posterior Multifocal Placoid Pigment Epitheliopathy

BACKGROUND AND OBJECTIVE: To describe retinal and choroidal findings in different stages of acute posterior multifocal placoid pigment epitheliopathy (APMPPE).PATIENTS AND METHODS: Retrospective, noncomparative case series studied by fundus biomicroscopy. fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), spectral-domain optical coherence tomographic (SD-OCT), and swept-source OCT angiography (SS-OCTA).RESULTS: Six eyes of three patients with bilateral APMPPE were included. FAF showed multifocal, branched patches of hyperautolluorescence with areas of hypoautofluorescence; FA disclosed early hypofluorescence, with late-phase hyperfluorescence; ICCA showed early and late-phase hypofluoresconce. SD-OCT imaging revealed bilateral retinal thinning, external limiting membrane (ELM) disruption, and severe alteration of the photoreceptor-retinal pigment epithelium complex. SS-OCTA showed widespread multiple dark spots in the choriocapillaris in Cases 1 and 2. Rarefaction and voids in the vascular texture were also detected in the deep plexus, unlike in Case 3, where the lesions were smaller and earlier, suggesting that retina vasculature may be affected after the choriocapillaris obstruction.CONCLUSIONS: APMPPE may result from a distinct focal ischemia in the choriocapillaris, and OCTA allowed the authors to localize exactly all the placoid lesions and monitor the areas of absent fluid signal.