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am meisten angesehen - 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 - Color1718 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 1503 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 1411 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 1404 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color1322 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescence1251 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color1187 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram1150 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Sequential color photos show progression1146 x angesehenVision in right eye dropped to 5/200 by the last photo.	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescence1130 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color1091 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescence1052 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescence1030 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color1026 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram981 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Sequential color photos show progression981 x angesehenVision in right eye dropped to 5/200 by the last photo.
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color980 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram944 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 940 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Red Free Photo932 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram925 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	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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram921 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram913 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram898 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram890 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram881 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram880 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photo868 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Red Free866 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photo862 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram855 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram850 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram831 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram823 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photo818 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photo813 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram811 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram807 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram797 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram783 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color757 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset756 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram755 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram755 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram754 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram740 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram732 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram711 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset702 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram699 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	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram695 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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset646 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset622 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset614 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset603 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset601 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset597 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset576 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset573 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset560 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset560 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset559 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	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
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset550 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset549 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset536 x angesehen4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis	Acute posterior multifocal placoid pigment epitheliopathy267 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.