Acute posterior multifocal placoid pigment epitheliopathy
Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) is a chorioretinal disease[1] in which light-coloured lesions begin to form in the posterior pole and inside the retina of the eye. Over time, the lesions cause vision loss that can go from mild to severe, but with no pain involved. Classified as an inflammatory disorder that is acute, but self-limiting, the lesions leave behind scarring, but visual acuity eventually improves.[2]
It occurs equally between genders, but is more likely to affect a person between the ages of 20 to 40. Also, it is known to occur after a systemic infection, showing that it is related generally to a depressed immune system. Recurrent episodes can happen if the infection was originally unilateral, with the second eye becoming infected even up to years after the initial infection, though most recurrences happen in less than six months.[3]
Signs
The formation of multiple lesions is the only informative sign of the presence of the disease. These lesions may be colored from grey-white[3] to a cream-shaded yellow.[4] The edges of the lesions are indistinct and have no true pattern or formation, but are generally similar in size. Though it is possible for some adjacent lesions to join together and cover a larger, overall area. It is quite likely for there to be some sort of liquid discharge from the eye, caused by the inflammation. The distortion of vision and area of effect depends on the placement and number of lesions in the eye.
Eventually, the lesions begin to clear up and disappear, giving the eye a light, mottled shade. It is possible for mild scarring to appear and for choroidal neovascularization to occur as late onset signs.[3]
Symptoms
General symptoms include:
Etiology
The origin of the infection remains unknown, with various theories of it occurring as an immune response to a larger infection[3][4], or the possibility of it being viral because of the preceding flu-like illness that generally accompanies it.[1]
Aftereffects
While vision does improve in almost all cases, it is rare that a person recovers complete eyesight. Often, eyesight remains impaired by having a lower acuity than previously and some of the symptoms can remain indefinitely. Long-term diagnosis is good for most cases, but with more than half reporting some visual disturbance in the center of the eye.[5]
However, some side effects of the disease can be neurological, such as strokes, and different brain infections. These occurrences can start with mild headaches that steadily increase in pain and threshold and include attacks of dysesthesia. It has been found that this type of deterioration happens usually if the lesions infect the fovea.[1]
There have been increasing reports of APMPPE having the effect of cerebrovascular damage, including cerebral artery damage from inflammation. A considerable connection can be made between the infection and later cases of cerebral vasculitis.[4]
References
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- Bugnone, A.N. "Acute and Chronic Brain Infarcts on MR Imaging in a 20-Year-Old Woman with Acute Posterior Multifocal Placoid Pigment Epitheliopathy - American Journal of Neuroradiology". http://www.ajnr.org/index.dtl. Retrieved 2009-09-15. External link in
|publisher=(help) - O’Halloran, Henry. "Acute multifocal placoid pigment epitheliopathy and central nervous system involvement: Nine new cases and a review of the literature - Ophthalmology". http://www.ophsource.org/periodicals/ophtha/home. Retrieved 2009-09-15. External link in
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