Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE
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25-year-old man was seen in the office on August 24, 2012. Starting about one and half weeks ago he woke up with night chills. He had a cold. He never took his temperature. He is not sure whether he had a fever. Also around that time his joints started hurting him, specifically his elbows, knees and ankles. He also has headaches, although the headache at this point is not severe, it is actually a little less than his usual headache and does not appear to be escalating. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision. They are a little bit off to the side.
VISUAL ACUITY: OD 20/32, OS 20/32. IOP: 16 OU.
SLIT EXAMINATION: There is 1+ cell and flare of the anterior chamber in both eyes with clear lenses. There are no iris nodules.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation and 1+ vitreous cells. There are some splotchy white geographic areas in the posterior pole.
OS: Vertical C/D ratio is 0.2. There is no posterior vitreous separation. There are 1+ vitreous cells. Again, there are splotchy white geographic areas in the posterior pole. In neither eye do the white spots involve the center of the macula.
FUNDUS PHOTOGRAPHY - AUTO FLUORESCENCE: The image in the left eye shows patches of hyper auto fluorescence corresponding to the areas of involvement.
FUNDUS PHOTOGRAPHY - INFRA RED: The image shows very little change, it is nearly normal.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows as you would expect, early hypofluorescence corresponding to the lesions and they are more visible on the fluorescein angiogram than they are funduscopically. In the later frames the lesions stain fairly uniformly throughout the center of them and there is even a little bit of leakage possibly associated with them. The left eye similarly shows early blocking and late staining.
INDOCYANINE GREEN ANGIOGRAPHY: The indocyanine green angiogram, which was shot out to fifteen minutes shows dense geographic blocking of the indocyanine green in the geographic areas. There are many more spots visible on indocyanine green angiogram than there are either on funduscopic or on fluorescein angiogram.
SPECTRALIS-SD-OCT SCAN: The OCT scan of the right eye shows the lesions to be predominately in the deep retina. There is clear loss of the photoreceptor integrity. The pigment epithelium looks normal in the area of the lesions, but above that the photoreceptor outer segments all the way up to the external limiting membrane lose their normal architecture and in some areas where the lesions are a little bit fresher, it looks like there is loss of the entire outer segment of the photoreceptors with only preservation of the nuclei. There is no evidence of any serous retinal detachment in either eye. The left eye similarly on the OCT scan shows over the lesion again a loss of photoreceptor integrity. There does appear to be a little bit of pigment epithelial irregularity over the dense lesion inferior to the fovea. The involvement goes all the way from the outer plexiform layer out to the retinal pigment epithelium. The edges of the lesions are sharp and no evidence of any spreading around them.
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Colorvaatamisi: 1611 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Colorvaatamisi: 1095 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Colorvaatamisi: 888 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Colorvaatamisi: 1204 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Colorvaatamisi: 1011 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Colorvaatamisi: 913 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Colorvaatamisi: 703 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photovaatamisi: 779 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photovaatamisi: 801 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photovaatamisi: 752 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photovaatamisi: 817 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescencevaatamisi: 1057 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescencevaatamisi: 951 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescencevaatamisi: 995 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescencevaatamisi: 1172 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Red Free Photovaatamisi: 876 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Red Freevaatamisi: 807 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogramvaatamisi: 1093 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogramvaatamisi: 835 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogramvaatamisi: 874 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogramvaatamisi: 826 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogramvaatamisi: 704 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogramvaatamisi: 737 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogramvaatamisi: 773 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogramvaatamisi: 901 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogramvaatamisi: 763 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogramvaatamisi: 860 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogramvaatamisi: 811 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogramvaatamisi: 668 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogramvaatamisi: 640 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogramvaatamisi: 784 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogramvaatamisi: 844 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogramvaatamisi: 824 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogramvaatamisi: 708 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogramvaatamisi: 692 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogramvaatamisi: 661 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogramvaatamisi: 886 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogramvaatamisi: 647 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogramvaatamisi: 875 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogramvaatamisi: 682 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogramvaatamisi: 738 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogramvaatamisi: 769 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogramvaatamisi: 705 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogramvaatamisi: 760 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT vaatamisi: 848 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT vaatamisi: 1340 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT vaatamisi: 1301 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT vaatamisi: 1448 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Sequential color photos show progressionvaatamisi: 1075Vision in right eye dropped to 5/200 by the last photo.
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Sequential color photos show progressionvaatamisi: 912Vision in right eye dropped to 5/200 by the last photo.
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 6504 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 5504 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 5604 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 5864 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 5044 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 5144 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 5444 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 4944 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 5184 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 5034 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 4974 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 5364 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 5484 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 5014 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 4804 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 4784 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onsetvaatamisi: 6984 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 hinnangut)
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Acute posterior multifocal placoid pigment epitheliopathyvaatamisi: 193
(0 hinnangut)
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25-year-old man was seen in the office on August 24, 2012. Starting about one and half weeks ago he woke up with night chills. He had a cold. He never took his temperature. He is not sure whether he had a fever. Also around that time his joints started hurting him, specifically his elbows, knees and ankles. He also has headaches, although the headache at this point is not severe, it is actually a little less than his usual headache and does not appear to be escalating. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision. They are a little bit off to the side.
VISUAL ACUITY: OD 20/32, OS 20/32. IOP: 16 OU.
SLIT EXAMINATION: There is 1+ cell and flare of the anterior chamber in both eyes with clear lenses. There are no iris nodules.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation and 1+ vitreous cells. There are some splotchy white geographic areas in the posterior pole.
OS: Vertical C/D ratio is 0.2. There is no posterior vitreous separation. There are 1+ vitreous cells. Again, there are splotchy white geographic areas in the posterior pole. In neither eye do the white spots involve the center of the macula.
FUNDUS PHOTOGRAPHY - AUTO FLUORESCENCE: The image in the left eye shows patches of hyper auto fluorescence corresponding to the areas of involvement.
FUNDUS PHOTOGRAPHY - INFRA RED: The image shows very little change, it is nearly normal.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows as you would expect, early hypofluorescence corresponding to the lesions and they are more visible on the fluorescein angiogram than they are funduscopically. In the later frames the lesions stain fairly uniformly throughout the center of them and there is even a little bit of leakage possibly associated with them. The left eye similarly shows early blocking and late staining.
INDOCYANINE GREEN ANGIOGRAPHY: The indocyanine green angiogram, which was shot out to fifteen minutes shows dense geographic blocking of the indocyanine green in the geographic areas. There are many more spots visible on indocyanine green angiogram than there are either on funduscopic or on fluorescein angiogram.
SPECTRALIS-SD-OCT SCAN: The OCT scan of the right eye shows the lesions to be predominately in the deep retina. There is clear loss of the photoreceptor integrity. The pigment epithelium looks normal in the area of the lesions, but above that the photoreceptor outer segments all the way up to the external limiting membrane lose their normal architecture and in some areas where the lesions are a little bit fresher, it looks like there is loss of the entire outer segment of the photoreceptors with only preservation of the nuclei. There is no evidence of any serous retinal detachment in either eye. The left eye similarly on the OCT scan shows over the lesion again a loss of photoreceptor integrity. There does appear to be a little bit of pigment epithelial irregularity over the dense lesion inferior to the fovea. The involvement goes all the way from the outer plexiform layer out to the retinal pigment epithelium. The edges of the lesions are sharp and no evidence of any spreading around them.
