Choroidal Involvement in Acute Posterior Multifocal Placoid Pigment Epitheliopathy

Mrejen, Sarah; Sarraf, David; Chexal, Saradha; Wald, Kenneth J.; Freund, K. Bailey

doi:10.3928/23258160-20151214-03

Cited by 62 publications

(37 citation statements)

References 14 publications

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“…OCTA is of great importance in revealing that within the corresponding hypofluorescent spots of ICGA, the choriocapillaris and retinal capillary blood flow are completely normal. This reinforces the concept that choriocapillaris may not be involved in this disease and the primary cause of it stands at the level of RPEphotoreceptor complex [1,23,[47][48][49] Acute posterior multifocal placoid pigment epitheliopathy FFA demonstrates early hypofluorescence of the acute posterior multifocal placoid pigment epitheliopathy (APMPPE) lesions and late hyperfluorescence due to staining [50][51][52]. APMPPE has been proposed to be a result of ischemia and acute inflammation of the choriocapillaris, but not of the medium and large sized choroidal vessels, leading to RPE abnormalities [53][54][55].…”

Section: Oct-a In Choroiditis (Choriocapillaropathies and Stromal Chosupporting

confidence: 79%

“…This inner choroidal involvement as prominent feature is supported by the ICGA findings of hypofluorescent areas corresponding to the lesions observed on FFA [51,52,56,57]. OCT imaging manifests increased inner choroidal hyporeflectivity or lucency [52,58], ellipsoid zone disruption and sub-RPE drusenoid abnormalities with RPE atrophy ensuing in the course of the disease, all of which co-localize with the primary zone of choroidal hypoperfusion [1,59]. OCTA imaging confirmed that hypothesis of inner choroidal or choriocapillaris flow reduction, as it illustrates true choriocapillaris flow-void areas that correspond to the ICGA hypofluorescent spots and are of the same or larger size.…”

Section: Oct-a In Choroiditis (Choriocapillaropathies and Stromal Chosupporting

confidence: 67%

“…APMPPE has been proposed to be a result of ischemia and acute inflammation of the choriocapillaris, but not of the medium and large sized choroidal vessels, leading to RPE abnormalities [53][54][55]. This inner choroidal involvement as prominent feature is supported by the ICGA findings of hypofluorescent areas corresponding to the lesions observed on FFA [51,52,56,57]. OCT imaging manifests increased inner choroidal hyporeflectivity or lucency [52,58], ellipsoid zone disruption and sub-RPE drusenoid abnormalities with RPE atrophy ensuing in the course of the disease, all of which co-localize with the primary zone of choroidal hypoperfusion [1,59].…”

Section: Oct-a In Choroiditis (Choriocapillaropathies and Stromal Chomentioning

confidence: 89%

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Optical coherence tomography angiography in uveitis

Tranos¹,

Karasavvidou

Gkorou³

et al. 2019

J Ophthal Inflamm Infect

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Before the introduction of optical coherence tomography angiography (OCTA) in the early 2000s, dye-based angiography was considered the "gold standard" for the diagnosis and monitoring of ocular inflammation. OCTA is a novel technique, which demonstrates capillary networks based on the amount of light returned from moving blood cells, providing further information on pathophysiological changes in uveitis. The aim of this review is to describe the basic principles of OCTA and its application to ocular inflammatory disorders. It particularly emphasizes on its contribution not only in the diagnosis and management of the disease but also in the identification of possible complications, comparing it with fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA). Although the advent of OCTA has remarkably enhanced the assessment of uveitic entities, we highlight the need for further investigation in order to better understand its application to these conditions.

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Section: Oct-a In Choroiditis (Choriocapillaropathies and Stromal Chosupporting

confidence: 79%

Section: Oct-a In Choroiditis (Choriocapillaropathies and Stromal Chosupporting

confidence: 67%

Section: Oct-a In Choroiditis (Choriocapillaropathies and Stromal Chomentioning

confidence: 89%

See 1 more Smart Citation

Optical coherence tomography angiography in uveitis

Tranos¹,

Karasavvidou

Gkorou³

et al. 2019

J Ophthal Inflamm Infect

View full text Add to dashboard Cite

show abstract

“…The ability to visualize large choroidal vessels on ICGA in areas of acute lesions make the possibility of blocked cyanescence by the RPE less likely and support the second theory. Subacute lesions with choroidal flow deficits on FA without structural OCT or autofluorescence findings have been previously identified, most recently by Mrejen et al 21 Furthermore, an incomplete overlap between acute lesions and areas of hypo-autofluorescence (and RPE changes) provides further evidence for a primarily choroidal disease. However, inconsistencies remain in the interpretation of the ICGA findings including the lack of correlation between the hypocyanescence and choroidal anatomy.…”

Section: Discussionmentioning

confidence: 80%

Acute Posterior Multifocal Placoid Pigment Epitheliopathy on Optical Coherence Tomography Angiography

Heiferman

Rahmani

Jampol

et al. 2017

Retina

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Purpose To investigate choroidal involvement in acute posterior multifocal placoid pigment epitheliopathy (APMPPE). Methods A retrospective observational case series using multimodal imaging including optical coherence tomography angiography (OCTA). Results Five patients with APMPPE were included. In most acute lesions, OCTA revealed outer retinal and retinal pigment epithelium (RPE) hyper-reflective lesions with attenuated OCT signal in the underlying choroid, but careful examination allowed us to identify a single lesion with decreased choriocapillaris flow outside the signal attenuation. OCTA obtained after healing of lesions revealed areas of hypo-intense circular flow voids clustered in groups surrounded by either iso- or hyper-intense signal background. Point-by-point evaluation revealed these flow voids did not correspond to areas of RPE thickening or focal pigmentary changes. Larger hypo-intense lesions were observed and did correlate with pigmentary changes. Conclusions Our case series demonstrates choriocapillaris flow abnormalities in acute APMPPE extending beyond the OCT lesions, and distinct residual vascular abnormalities in healed APMPPE lesions on OCTA. Our findings support a primary ischemic insult to the photoreceptors and RPE, but choriocapillaris flow abnormalities could be secondary to (OCT invisible) retinal and RPE involvement. The lack of understanding of the etiology along with the inability to visualize most of the choroid in acute lesions preclude definite conclusions about the true pathogenesis of APMPPE.

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“…Controversy has persisted regarding the pathogenesis of APMPPE since its initial description by Gass [ 21 ], who chose the term “pigment epitheliopathy” to reflect the most significant clinical tissue involvement. However, the advent of ICGA in the 1990s has provided additional insights into APMPPE and has supported choroidal involvement as a prominent feature [ 22 ]. Still, several features of APMPPE remained atypical for a choroiditis including the rapid resolution of lesions and the near absence of damage to the choroid despite significant permanent alternations in the RPE.…”

Section: Reviewmentioning

confidence: 99%

Pearls and pitfalls of optical coherence tomography angiography in the multimodal evaluation of uveitis

Pichi

Sarraf

Morara

et al. 2017

J Ophthal Inflamm Infect

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BackgroundOptical coherence tomography angiography (OCTA) employs a novel imaging algorithm that detects the amplitude or phase decorrelation of blood cell movement. It thus provides a flow map with depth-resolved visualization of the various vascular layers in the posterior pole of the eye including the retina capillary plexus and the choroid.In the past 3 years, the number of research papers on the subject of OCTA in retinal diseases has grown exponentially including important applications in the field of uveitis. While the study of OCTA in uveitic diseases has gained remarkable relevance worldwide, interpretation can be challenging, and many limitations exist in optimally using this advanced system in uveitic eyes.The aim of this review is to describe the many significant applications of OCTA in uveitis disorders and to outline the various limitations that can confound interpretation and support uveitis specialists in the integration of OCTA in the multimodal imaging approach to inflammatory diseases.Main bodyUnlike conventional angiography that can dynamically detect inflammation and leakage of dye from retinal vessels, OCTA provides other important biomarkers of inflammation. Detailed microvascular reconstruction of normal and abnormal blood vessels and quantitative evaluation are advantages of OCTA analysis. OCTA can therefore non-invasively detect choroidal neovascularization that may complicate inflammatory disorders, and with remarkable depth-resolved capability, OCTA can identify and quantitate flow loss as a manifestation of ischemia and/or inflammation.The areas of flow deficit on OCTA at the level of the inner choroid often co-localize with hypofluorescent lesions with indocyanine green angiography. These regions of presumed choriocapillaris ischemia may occur in placoid disorders. Space-occupying granulomas may occur in disorders such as sarcoid and may or may not co-localize with choriocapillaris ischemia on ICG angiography. Blocking or shadowing artifacts should be excluded when evaluating inner choroidal abnormalities with OCT angiography.Fundus autofluorescence may assess the metabolic function of the retinal pigment epithelium (RPE) and the viability of the overlying photoreceptors and thus the activity of inflammation associated with uveitic lesions. The photoreceptors are physiologically maintained by the diffusion of oxygen from the choriocapillaris below and, to a lesser extent, from the deep retinal capillary plexus above. The depth-resolved capability of OCTA may therefore provide additional significant microvascular information about these vascular layers that may be driving the development of hyper-autofluorescent RPE inflammation and photoreceptor loss.ConclusionsThe implementation of OCTA in the evaluation and management of uveitis disorders is being spurred by our greater knowledge and understanding of its application. In order to take full advantage of this exciting new imaging modality, however, uveitis specialists must understand the limitations of interpretation and potential art...

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Choroidal Involvement in Acute Posterior Multifocal Placoid Pigment Epitheliopathy

Abstract: These results suggest a transient ischemic choroiditis in APMPPE that may lead to secondary permanent retinal pigment epithelium damage in the posterior pole but not in the retinal periphery.

Cited by 62 publications

References 14 publications

Optical coherence tomography angiography in uveitis

Optical coherence tomography angiography in uveitis

Acute Posterior Multifocal Placoid Pigment Epitheliopathy on Optical Coherence Tomography Angiography

Pearls and pitfalls of optical coherence tomography angiography in the multimodal evaluation of uveitis

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