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Most viewed - Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE 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.
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color1609 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 1440 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 1334 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 1295 views 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color1202 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescence1170 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color1090 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram1089 views 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Sequential color photos show progression1070 viewsVision in right eye dropped to 5/200 by the last photo.	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescence1054 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color1002 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescence992 views 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescence950 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color908 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Sequential color photos show progression908 viewsVision in right eye dropped to 5/200 by the last photo.	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram893 views 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color885 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram885 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Red Free Photo873 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram872 views 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram869 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram857 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 844 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram842 views 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram831 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram823 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram821 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photo817 views 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram811 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Red Free805 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photo799 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram782 views 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photo777 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram769 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram759 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram759 views 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram756 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photo752 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram727 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram725 views 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram707 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram699 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram699 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color698 views 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset698 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram690 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram673 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram668 views 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram658 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram647 views 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset647 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram640 views 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset581 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset554 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset550 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset548 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset543 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset535 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset517 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset513 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset500 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset499 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset499 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset494 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset493 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset480 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset478 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute posterior multifocal placoid pigment epitheliopathy192 views
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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.