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CHARACTERIZING PHOTORECEPTOR CHANGES IN ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY USING ADAPTIVE OPTICS

Roberts, Philipp, K., MD*,†; Nesper, Peter, L., BA*; Onishi, Alex, C., BA*; Skondra, Dimitra, MD, PhD*; Jampol, Lee, M., MD*; Fawzi, Amani, A., MD*

doi: 10.1097/IAE.0000000000001520
Original Study
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Purpose: To characterize lesions of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) by multimodal imaging including adaptive optics scanning laser ophthalmoscopy (AOSLO).

Methods: We included patients with APMPPE at different stages of evolution of the placoid lesions. Color fundus photography, spectral domain optical coherence tomography, infrared reflectance, fundus autofluorescence, and AOSLO images were obtained and registered to correlate microstructural changes.

Results: Eight eyes of four patients (two women) were included and analyzed by multimodal imaging. Photoreceptor reflectivity within APMPPE lesions was more heterogeneous than in adjacent healthy areas. Hyperpigmentation on color fundus photography appeared hyperreflective on infrared reflectance and on AOSLO. Irregularity of the interdigitation zone and the photoreceptor inner and outer segment junctions (IS/OS) on spectral domain optical coherence tomography was associated with photoreceptor hyporeflectivity on AOSLO. Interruption of the interdigitation zone or IS/OS was associated with loss of photoreceptor reflectivity on AOSLO.

Conclusion: Irregularities in the reflectivity of the photoreceptor mosaic are visible on AOSLO even in inactive APMPPE lesions, where the photoreceptor bands on spectral domain optical coherence tomography have recovered. Adaptive optics scanning laser ophthalmoscopy combined with multimodal imaging has the potential to enhance our understanding of photoreceptor involvement in APMPPE.

In this study, the authors examined patients with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) using multimodal imaging including adaptive optics scanning laser ophthalmoscopy (AOSLO). Photoreceptor alterations on AOSLO were meticulously coregistered with different standard imaging modalities.

*Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and

Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.

Reprint requests: Amani A. Fawzi, MD, Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue #440, Chicago, IL 60611; e-mail: afawzimd@gmail.com

Instrument support was provided by Boston Micromachines Corporation. The funding agencies had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

None of the authors has any conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.