Case reports in ophthalmological medicine
A Case of Acute Posterior Multifocal Placoid Pigment Epitheliopathy Associated With Anterior Ischemic Optic Neuropathy
By Ikeda M, Oshitari T and Usui T.
Abstract
Introduction
We report a case of unilateral presumed nonarteritic anterior ischemic optic neuropathy (NAION) associated with acute posterior multifocal placoid pigment epitheliopathy (APMPPE).
Case presentation
A 59-year-old female presented with blurred left vision for 9 days. At the initial examination, her best-corrected visual acuities (BCVAs) were 20/16 OD and 20/30 OS. No signs of inflammation were observed in the anterior chamber or vitreous. The critical fusion frequency (CFF) was 38 Hz in OD and 27 Hz in OS. Fundus examination revealed optic disc edema in the left eye and multiple placoid lesions in both eyes. Optical coherence tomography showed a serous retinal detachment (SRD) beneath the macula of the left eye. Humphrey field analysis revealed visual field defects in the inferonasal sectoral area at the left eye and mild concentric constrictions in both eyes. Fluorescein angiography revealed early hypofluorescence and late hyperfluorescence in the superotemporal region of the left optic nerve swelling and placoid lesions in both eyes. Indocyanine green angiography revealed multiple hypofluorescent spots in both eyes from the early to late phases. Based on the above findings, a diagnosis of APMPPE complicated by left presumed NAION was made, and oral prednisolone 30 mg/day was started. After 2 months, the left BCVA improved to 20/16, CFF recovered to 37 Hz and SRD and optic nerve edema disappeared. Mild concentric constrictions improved in both eyes but the inferonasal sectoral visual field defects persisted in the left eye; the left nerve fibre layer thinning appeared to be consistent with the remaining inferonasal sectoral visual field defects.