A syndrome resembling acute posterior multifocal placoid pigment epitheliopathy in older adults.

Abstract

To describe clinical characteristics and visual and anatomic outcomes of a syndrome in older patients that is similar in its active stage to acute posterior multifocal placoid pigment epitheliopathy, but has a distinct clinical course. We retrospectively reviewed medical records and photographic studies of consecutive patients over the age of 50 who presented with acute-onset visual symptoms associated with flat, gray-white lesions at the level of the retinal pigment epithelium reminiscent of acute posterior multifocal placoid pigment epitheliopathy. The cohort included four men and two women with a median age of 72.5 (range, 58-82) years. The disease course was characterized by recurrent episodes in 6 (55%) of 11 eyes, with initial or eventual bilaterality in all five binocular patients. Five of six patients were treated with corticosteroids and all six patients experienced significant short-term improvement in visual acuity. However, 8 (73%) of 11 eyes developed progressive geographic atrophy and 7 (64%) developed choroidal neovascularization. With a mean (+/-SD) follow-up time of 6.6 +/- 5.5 years, the final visual acuity was 20/200 or worse in 8 (73%) of 11 eyes. Although older patients presenting with acute posterior multifocal placoid pigment epitheliopathy-like lesions are likely to experience visual improvement as acute lesions resolve, geographic atrophy and choroidal neovascular membrane formation may subsequently develop, leading to moderate or severe visual loss.