Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is an uncommon, self-limited idiopathic condition that was first described by Gass in 1968. 1 APMPPE typically affects young, healthy individuals with a bilateral distribution at onset or, if initially unilateral, involvement of the fellow eye within days to weeks. Over one third of patients report a preceding viral or flu-like illness. 1,2 Visual complaints include photopsias, blurred vision, and paracentral scotomas, with vision being more significantly decreased in cases with foveal involvement. 3,4 Visual prognosis is generally good, with 87% of patients without foveal involvement recovering visual acuity of 20/25 or better. 5 Recurrence of APMPPE has been reported 6 but is uncommon. Cerebral vasculitis is a rare but lifethreatening complication occurring simultaneously or months after onset of ocular disease. 7 A variant, relentless placoid chorioretinitis, has a worse prognosis and shares findings and behavior similar to both APMPPE and serpiginous choroidopathy. 8 The incidence of APMPPE is unclear, but a recently published multicentered 20-year retrospective study showed an annual incidence of 0.15 per 100,000 people in a primarily white demographic. 9 There is no consistently reported sex predilection.Although the etiology of APMPPE is uncertain, it is currently believed to be secondary to a hypersensitivity-induced obstructive vasculitis, resulting in hypoperfusion of terminal choroidal lobules in the posterior pole. These changes result in ischemic injury of the overlying retinal pigment epithelium (RPE) and photoreceptors. Choroidal hypoperfusion within APMPPE lesions, 10 delay of fundus autofluorescence (FAF) changes behind fluorescein angiography (FA) and indocyanine green angiography (ICG) changes, the fact that areas of choroidal hypoperfusion are more

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