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 - Color1738 x angesehen 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
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color1205 x angesehen 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
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color1001 x angesehen 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
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color1344 x angesehen 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
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color1108 x angesehen 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
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color1045 x angesehen 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
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color768 x angesehen 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
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photo830 x angesehen 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
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photo877 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photo829 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photo875 x angesehen 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
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescence1139 x angesehen 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
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescence1039 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescence1064 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescence1264 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Red Free Photo939 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Red Free875 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram1159 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram916 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram936 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram889 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram768 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram819 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram822 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram989 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram834 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram935 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram891 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram736 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram704 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram857 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram922 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram897 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram764 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram791 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram717 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram954 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram708 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram931 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram749 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram805 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram862 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram763 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram839 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 949 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 1421 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 1414 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 1521 x angesehen 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 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Sequential color photos show progression1150 x angesehenVision in right eye dropped to 5/200 by the last photo.
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Sequential color photos show progression993 x angesehenVision in right eye dropped to 5/200 by the last photo.
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset708 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset628 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset620 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset652 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset568 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset588 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset604 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset570 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset586 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset556 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset564 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset609 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset615 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset571 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset555 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset585 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 Bewertungen)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset775 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
(0 Bewertungen)
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Acute posterior multifocal placoid pigment epitheliopathy287 x angesehen
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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.
