CLINICALCASE PROVOST J, SEKFALI R, AMOROSO F, ZAMBROWSKI O, MIERE A Department of ophthalmology, Souied E. (MD,PhD) Centre Hospitalier Intercommunal de Créteil Université Paris Est
HISTORY 13 years old girl Right Eye Left Eye Origin: Morocco Her medical history is unremarkable Symptoms Headaches Blurred vision in the last 2 weeks Right eye Central scotoma Visual acuity 20/100 20/20 Slit lamp No inflammatory signs Intra ocular pressure 19 18 No inflammatory signs
COLOR FUNDUS
Autofluorescence
Visual Field
Early phase
Multifocal ElectroRetinogram RIGHT EYE LEFT EYE
Diagnosis?
CASES OF MACULAR STIPPLED PIGMENTED LESIONS Acute posterior multifocal choroiditis Multiple evanescent white dot syndrome Acute posterior multifocal placoid pigment epitheliopathy Acute unilateral idiopathic maculopathy Serpignnous choroiditis Punctuate inner choroidopathy Multifocal choroiditis Laser induced retinopathy Acute retinal pigment epithilitiis
WORKUP Immunology AAN : negative Bartonella : negative Angiotensin converting enzyme : N Infectious diseases Tuberculosis (INF G) negative TPHA VDRL Toxoplasmosis Toxocariasis Zika virus HSV VZV = vaccinal status + Lyme = WB + (IgM) / ELISA - MRI Brain Thoracic CT scanner
CASES OF MACULAR STIPPLED PIGMENTED LESIONS Acute posterior multifocal choroiditis Multiple evanescent white dot syndrome Acute posterior multifocal placoid pigment epitheliopathy Acute unilateral idiopathic maculopathy Serpignnous choroiditis Punctuate inner choroidopathy Multifocal choroiditis Laser induced retinopathy Acute retinal pigment epithilitiis
Solution 1 AUIM : Acute Unilateral Idiopathic Maculopathy
Physiopathology Coxsackievirus infection Epidemiology Rare disease Young people A prodromal flu-like illness Symptoms Acute onset of unicentral central visual lost Evolution Spontaneously recovery (few weeks) Srour M, Querques G, Rostaqui O, Souied EH. Early spectral-domain optical coherence tomography findings in unilateral acute idiopathic maculopathy. Retina. 2013 Nov-Dec;33(10):2182-4
Physiopathology Coxsackievirus infection Epidemiology Rare disease Young people A prodromal flu-like illness Symptoms Acute onset of unicentral central visual lost Evolution Spontaneously recovery (few weeks) Srour M, Querques G, Rostaqui O, Souied EH. Early spectral-domain optical coherence tomography findings in unilateral acute idiopathic maculopathy. Retina. 2013 Nov-Dec;33(10):2182-4
Solution 2 PUNCTUATE INNER CHOROIDOPATHY
PIC Punched-out chorioretinal lesions Fundus biomicroscopy Acute : gray or yellow lesions Older: yellow-white atrophic No inflammatory cells Physiopathology Precise etipathogenesis remains unclear Epidemiology Young healthy Myopic women No known associated systemic disease Symptoms Photopsia Floaters A temporal blind spot / enlarged blind spot Munk MR, Jung JJ, Biggee K, Tucker WR, Sen HN, Schmidt-Erfurth U, Fawzi AA, Jampol LM. Idiopathic multifocal choroiditis/punctate inner choroidopathy with acute photoreceptor loss or dysfunction out of proportion to clinically visible lesions. Retina. 2015 Feb;35(2):334-43
Solution 2 PONCTUATE INNER CHOROIDOPATHY
Solution 3 ACUTE RETINAL PIGMENT EPITHELIITIS
Acute retinal pigment epitheliitis (ARPE), also known as Krill s disease, has been described by Krill and Deutman in 1972 Physiopathology Unknown transient dysfunction or inflammation at the interface between the RPE and photoreceptor outer segments Epidemiology Young, healthy adults Males = females Rare disease Unilateral or bilateral Evolution Spontaneously resolved (few months) Incomplete recovery Outer layer nuclear External Layer Membrane Recurrence rare but possible Acute Retinal Pigment Epitheliitis: Spectral-Domain Optical Coherence Tomography Findings in 18 Cases; Han Joo Cho, Sang Youn Han, Sung Won Cho, Dong Won Lee, Tae Gon Lee, Chul Gu Kim,and Jong Woo Kim. Department of Ophthalmology, Kim s Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, South Korea
Acute Retinal Pigment Epitheliitis: Spectral-Domain Optical Coherence Tomography Findings in 18 Cases; Han Joo Cho, Sang Youn Han, Sung Won Cho, Dong Won Lee, Tae Gon Lee, Chul Gu Kim,and Jong Woo Kim. Department of Ophthalmology, Kim s Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, South Korea
ARPE: DIAGNOSTIC CRITERIA 1. Presented with acute visual blurring or central scotoma 2. Localized areas of pigment stippling associated with yellowish, often halo-like, zones of hypopigmentation in the fovea 3. No sign of any other ocular disease including anterior uveitis or vitritis Acute Retinal Pigment Epitheliitis: Spectral-Domain Optical Coherence Tomography Findings in 18 Cases; Han Joo Cho, Sang Youn Han, Sung Won Cho, Dong Won Lee, Tae Gon Lee, Chul Gu Kim,and Jong Woo Kim. Department of Ophthalmology, Kim s Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine, Seoul, South Korea
TAKE HOME MESSAGE - Fundus - Stippled lesions - Yellowish halo - Fluorescein angiography - Unremarkable findings - Or patchy macular hyperfluorescence - ICG angiography - Hyperfluorescence with central hypofluorescence at the macula - OCT - Disruption of the inner layer of the RPE, ISe line, and ELM Acute Retinal Pigment Epitheliitis: Spectral-Domain Optical Coherence Tomography Findings in 18 Cases; Han Joo Cho, Sang Youn Han, Sung Won Cho, Dong Won Lee, Tae Gon Lee, Chul Gu Kim,and Jong Woo Kim. Department of Ophthalmology, Kim s Eye Hospital, Myung-Gok Eye Research Institute, Konyang University College of Medicine,