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Phase-Variance Optical Coherence Tomographic Angiography Imaging of Choroidal Perfusion Changes Associated With Acute Posterior Multifocal Placoid Pigment Epitheliopathy

Susanna S. Park, MD, PhD1; Sumeer Thinda, MD1; Dae Yu Kim, PhD2; Robert J. Zawadzki, PhD1; John S. Werner, PhD1
[+] Author Affiliations
1Department of Ophthalmology and Vision Science, University of California, Davis Eye Center, Sacramento
2Beckman Laser Institute Korea and Biomedical Engineering, Dankook University, Cheonan, Chungnam, South Korea
JAMA Ophthalmol. 2016;134(8):943-945. doi:10.1001/jamaophthalmol.2016.1645.
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This case report uses phase-variance optical coherence tomographic angiography to demonstrate transient inner choroidal flow changes associated with acute posterior multifocal placoid pigment epitheliopathy.

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is characterized by bilateral multiple placoid white-gray lesions of the posterior pole at the level of the retinal pigment epithelium (RPE) and/or choriocapillaris, which self-resolve with recovery of vision.1,2 The etiology is unknown, but APMPPE has been associated with viral prodromes and vasculitis. The placoid lesions are thought to represent focal RPE inflammation or choriocapillaris ischemia based on fluorescein angiogram findings of early hypofluorescence and late hyperfluorescence.

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Figure 1.
Fundus Photograph and Fluorescein Angiogram of the Left Eye

At presentation, white-gray placoid lesions are seen (A), with early hypofluorescence (B) and late hyperfluorescence (C) on angiography; pigmentary changes developed by 6 weeks’ follow-up (D and E).

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Figure 2.
Left Macula Phase-Variance Optical Coherence Tomographic Angiography (pv-OCTA)

Choroidal perfusion (red, pv signal) superimposed on intensity OCT (A and D) and en face (B, C, E, and F). The images show patchy hypoperfusion of the choriocapillaris (B, green) and Sattler layer (C, blue) at presentation, resolving at 6 weeks’ follow-up (D-F). Image sizes are 1.5 mm × 1.5 mm centered in the fovea; scale bar, 500 µm). G, Spectral-domain OCT (SD-OCT) at 6 months’ follow-up. I indicates inferior; N, nasal; S, superior; and T, temporal.

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