Case ReportOPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY SHOWS INNER CHOROIDAL ISCHEMIA IN ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHYDolz-Marco, Rosa MD, PhD*,†; Sarraf, David MD‡,§; Giovinazzo, Vincent MD¶; Freund, K. Bailey MD*,†,**,††Author Information *Vitreous Retina Macula Consultants of New York, New York, New York; †LuEsther T Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York; ‡Retinal Disorders and Ophthalmic Genetics Division, Jules Stein Eye Institute, University of California, Los Angeles, California; §Greater Los Angeles VA Healthcare Center, Los Angeles, California; ¶Department of Ophthalmology, Staten Island University Hospital, New York, New York; **Department of Ophthalmology, Edward S Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York; and ††Department of Ophthalmology, New York University School of Medicine, New York, New York. Reprint requests: K. Bailey Freund, MD, Vitreous Retina Macula Consultants of New York, 460 Park Avenue, New York, NY 10022; e-mail: [email protected] Supported by a research grant from the LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, NY, and The Macula Foundation Inc, New York, NY. R. Dolz-Marco: Research grants from Alcon, Allergan, Bayer, Heidelberg Engineering, Novartis, Thea, and Roche. D. Sarraf: Research grants from Genentech, Regeneron, and Optovue. K. B. Freund: Consultant to Genentech, Optos, Optovue, Heidelberg Engineering, and Bayer HealthCare. The other author has no conflicting interests to disclose. Retinal Cases & Brief Reports: Winter 2017 - Volume 11 - Issue - p S136-S143 doi: 10.1097/ICB.0000000000000473 Buy Metrics AbstractIn Brief Purpose: To describe multimodal imaging findings of an evolving case of acute posterior multifocal placoid pigment epitheliopathy occurring in a young healthy male. Methods: Case report of a patient with acute posterior multifocal placoid pigment epitheliopathy including comprehensive systemic and ocular examinations. Ultra-widefield autofluorescence, fluorescein angiography, indocyanine green angiography, and serial optical coherence tomography angiography were performed. Results: A 34-year-old male presented with acute vision loss in his left eye for 2 weeks. His best-corrected visual acuity was 20/20 in his right eye and 20/200 in his left eye. Dilated funduscopic examination revealed multiple creamy white deep retinal lesions showing macular involvement of the left eye with a diffuse area of pigmentary changes. The presence of multiple areas of hypoperfusion of the inner choroid were demonstrated with fluorescein and indocyanine green angiography. Serial optical coherence tomography angiography showed multiple evolving areas of decreased flow at the level of the inner choroid. Conclusion: Although the pathogenesis of acute posterior multifocal placoid pigment epitheliopathy remains unknown, there is growing evidence of a primary choroidal involvement with secondary damage to the overlying retinal pigment epithelium and the outer retinal layers. Optical coherence tomography angiography may provide valuable information for the diagnosis and follow-up of this condition avoiding invasive angiographic procedures. The authors present a case of acute posterior multifocal placoid pigment epitheliopathy in a young healthy male. Serial optical coherence tomography angiography shows the occurrence of new areas of inner choroidal hypoperfusion without structural optical coherence tomography or autofluorescence changes.