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Fouad YA, Cicinelli MV, Marchese A, Casalino G, Jampol LM. Revisiting acute retinal pigment epitheliitis (Krill disease). Surv Ophthalmol 2024; 69:916-923. [PMID: 39025238 DOI: 10.1016/j.survophthal.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
We reevaluate acute retinal pigment epitheliitis (ARPE) first described by Krill and Deutman in 1972, integrating a meticulous literature review with advanced multimodal imaging analyses. Our review included 98 eyes from 86 published cases diagnosed with ARPE. We scrutinized ARPE's clinical presentations, variability, and imaging characteristics, revealing that a large majority (90 %) of cases previously diagnosed as ARPE align more closely with other retinal disorders based on modern diagnostic criteria and imaging techniques. Only a small fraction (5 eyes) did not fit into any known categories, casting doubt on ARPE's distinct existence. This underscores the critical role of multimodal imaging in redefining our understanding of macular diseases and challenges the historical classification of ARPE as a unique clinical entity.
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Affiliation(s)
- Yousef A Fouad
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
| | - Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Alessandro Marchese
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Casalino
- Ophthalmology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lee M Jampol
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Al-Nofal M, Charbel Issa P. Acute retinal pigment epitheliitis, a diagnostic myth? Eye (Lond) 2024; 38:238-239. [PMID: 37532834 PMCID: PMC10810810 DOI: 10.1038/s41433-023-02683-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023] Open
Affiliation(s)
- Mays Al-Nofal
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Peter Charbel Issa
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
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Caruso G, Marano F. A Long Term Recurrent Case of Acute Retinal Pigment Epithelitis. Ocul Immunol Inflamm 2023; 31:1730-1735. [PMID: 35901522 DOI: 10.1080/09273948.2022.2093752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 06/13/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To describe the case of a young adult who developed two episodes of Acute Retinal Pigment Epithelitis (ARPE) in the same eye 7 years apart, describing retinal morphologic changes using SD-OCT scan. OBSERVATIONS ARPE is an acute, self-limiting macular disorder characterized by a stippled dark macular lesion surrounded by a hypopigmented halo under fundus examination, corresponding to a foveal disruption of the outer retinal layers and an hyperreflective lesion under SD-OCT scan. Despite ARPE lesions usually appearing to be situated within the macula, a diffuse involvement of the RPE has been suggested1. SD-OCT scan in our patient showed multiple focal lesions involving the whole posterior pole of the affected eye. CONCLUSIONS AND IMPORTANCE We report the first case where a diffuse involvement of the RPE in the disease is supported by an OCT finding and the case with the longest period between two recurrent self-limited episodes described so far.
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Affiliation(s)
- Giulia Caruso
- Department of Ophthalmology, University Hospital "Policlinico Vittorio Emanuele", Catania, Italy
| | - Filippo Marano
- Department of Ophthalmology, "Azienda Ospedaliera per l'Emergenza Cannizzaro", Catania, Italy
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The OCT angular sign of Henle fiber layer (HFL) hyperreflectivity (ASHH) and the pathoanatomy of the HFL in macular disease. Prog Retin Eye Res 2022:101135. [DOI: 10.1016/j.preteyeres.2022.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/11/2022]
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González Escobar AB, Ibáñez García A, Chinchurreta Capote A, Gismero Moreno S, Lorenzo Soto M. Acute retinal pigment epitheliitis (ARPE). A case report. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:230-233. [PMID: 35523470 DOI: 10.1016/j.oftale.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/21/2020] [Indexed: 06/14/2023]
Abstract
A 35-year-old woman arrived in the emergency department due to loss of vision in the left eye. She had a subfoveal yellowish-looking lesion that, on optical coherence tomography (OCT), corresponded to a hyper-reflective lesion from the external nuclear layer to the retinal pigment epithelium. The lesion was reabsorbed at 6 weeks, leaving a discontinuity in the photoreceptor and retinal pigment epithelium lines. The patient was diagnosed with acute retinal pigmentary epitheliitis (ARPE). ARPE is a self-limiting disease with a good prognosis. Emphasis is placed on the importance of a correct diagnosis using funduscopy, OCT, and fluorescent angiography, in order to avoid unnecessary treatments.
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González Escobar AB, Ibáñez García A, Chinchurreta Capote A, Gismero Moreno S, Lorenzo Soto M. Acute retinal pigment epitheliitis (ARPE). A case report. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 97:S0365-6691(20)30489-5. [PMID: 33483172 DOI: 10.1016/j.oftal.2020.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/15/2020] [Accepted: 11/21/2020] [Indexed: 06/12/2023]
Abstract
A 35-year-old woman arrived in the emergency department due to loss of vision in the left eye. She had a subfoveal yellowish-looking lesion that, on optical coherence tomography (OCT), corresponded to a hyper-reflective lesion from the external nuclear layer to the retinal pigment epithelium. The lesion was reabsorbed at 6 weeks, leaving a discontinuity in the photoreceptor and retinal pigment epithelium lines. The patient was diagnosed with acute retinal pigmentary epitheliitis (ARPE). ARPE is a self-limiting disease with a good prognosis. Emphasis is placed on the importance of a correct diagnosis using funduscopy, OCT, and fluorescent angiography, in order to avoid unnecessary treatments.
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Wykrota AA, Löw U, Fries FN, Seitz B, Abdin AD. [Unilateral Irregularities in the Macular Pigment Epithelium in a 38-Year-Old Patient - "Acute Retinal Pigment Epitheliitis"]. Klin Monbl Augenheilkd 2020; 239:304-307. [PMID: 33036057 DOI: 10.1055/a-1241-4521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Agata Anna Wykrota
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Ursula Löw
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg/Saar
| | | | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Alaa Din Abdin
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg/Saar
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Optical coherence tomography diagnostic signs in posterior uveitis. Prog Retin Eye Res 2020; 75:100797. [DOI: 10.1016/j.preteyeres.2019.100797] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/31/2019] [Accepted: 09/05/2019] [Indexed: 12/22/2022]
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Li YH, Chang YC, Wu WC. Spectral-domain optical coherence tomography finding of acute retinal pigment epitheliitis. Taiwan J Ophthalmol 2020; 9:276-279. [PMID: 31942435 PMCID: PMC6947752 DOI: 10.4103/tjo.tjo_23_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 07/14/2019] [Indexed: 11/04/2022] Open
Abstract
Acute retinal pigment epitheliitis (ARPE) is a rare, transient macular disorder affecting healthy young adults. We describe the morphologic appearance of the retina by spectral-domain optical coherence tomography (SD-OCT) and to evaluate both the anatomic changes and the functional visual acuity changes over time in the course of disease. A 35-year-old healthy male presented with 1-week history of sudden-onset bilateral central scotoma with blurry vision. He denied trauma, excessive sun exposure, or drug abuse history or alkyl nitrites before. The medical and ocular examinations were unremarkable. The best-corrected visual acuity (BCVA) was 20/200 (OU) at the initial visit. Slit-lamp examination result was normal. Fundus examination revealed subfoveal yellowish lesions with a halo-like pigment in both eyes. The SD-OCT imaging showed subtle disruption of the retinal pigment epithelium (RPE) and abnormal hyperreflectivity throughout the full thickness of the foveola in both eyes. Six weeks later, the BCVA improved to 20/30 (OU) without any treatment. Six months later, the BCVA observed deteriorated to 20/50 (OU). SD-OCT demonstrated ellipsoid zone and cone outer segment tips line defects at the fovea with sharply defined borders. One year later from the initial visit, the BCVA improved to 20/20 (OU), but persisted macular microhole presents on the SD-OCT. The patient was followed for 1 year without any treatment. Thereafter, we noted that in the case of poor initial visual acuity, external limiting membrane, or outer nuclear layer involvement, as determined by SD-OCT, at the baseline might need longer time for visual acuity. The natural course of ARPE may involve the demonstration of a minor outer retinal defect that is similar to a macular microhole. In ARPE, like SD-OCT findings, the location of the initial lesion is the photoreceptor outer segments. It is not just limited to the RPE.
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Affiliation(s)
- Yi-Hsuan Li
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yo-Chen Chang
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Chuan Wu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Ophthalmology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Iu LP, Lee R, Fan MC, Lam WC, Chang RT, Wong IY. Serial Spectral-Domain Optical Coherence Tomography Findings in Acute Retinal Pigment Epitheliitis and the Correlation to Visual Acuity. Ophthalmology 2017; 124:903-909. [PMID: 28284786 DOI: 10.1016/j.ophtha.2017.01.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 10/20/2022] Open
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Benlahbib M, Meziani L, Akesbi J, Nordmann JP. [Acute Retinal Pigment Epitheliitis: spectral-domain optical coherence tomography findings]. J Fr Ophtalmol 2015; 38:333-9. [PMID: 25838057 DOI: 10.1016/j.jfo.2015.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 01/05/2015] [Accepted: 01/15/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Through a case presentation of Acute Retinal Pigment Epitheliitis (ARPE) we highlight the role of spectral-domain optical coherence tomography (SD-OCT) in the management of this rare entity. MATERIALS AND METHODS A 29-year-old woman presented for reduced visual acuity in the right eye occurring one week after a viral episode. Fundus examination showed zones of macular hyperpigmentation surrounded by yellowish hypopigmented haloes. Fluorescein angiography noted early hyperfluorescence of the hypopigmented lesions. ICG angiography revealed central hyperfluorescence surrounded by a hypofluorescent halo. SD-OCT showed a linear disruption between the photoreceptor inner/outer segments (IS/OS) and an accumulation of material in the photoreceptor outer segments and retinal pigment epithelium (RPE). Spontaneous normalization of visual acuity was noted after 10 weeks. SD-OCT revealed restored and continuous inner segment and outer segment layers and some persistent deposits in the photoreceptor layer. RESULTS SD-OCT findings suggest that the initial lesion in ARPE is located at the junction between the photoreceptor outer segments and the apical side of the RPE cells. It would correspond to an accumulation of photoreceptor outer segment debris secondary to RPE dysfunction, which can occur as a post-viral reaction. CONCLUSION SD-OCT provides very specific information about the topography of retinal lesions during ARPE, allowing a better understanding of its pathogenesis.
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Affiliation(s)
- M Benlahbib
- Service II, CHNO des XV-XX, 28, rue de Charenton, 75012 Paris, France.
| | - L Meziani
- Service II, CHNO des XV-XX, 28, rue de Charenton, 75012 Paris, France
| | - J Akesbi
- Service II, CHNO des XV-XX, 28, rue de Charenton, 75012 Paris, France
| | - J-P Nordmann
- Service II, CHNO des XV-XX, 28, rue de Charenton, 75012 Paris, France
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[OCT course in acute retinal pigment epithelitis]. J Fr Ophtalmol 2015; 38:365-7. [PMID: 25791702 DOI: 10.1016/j.jfo.2014.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 09/01/2014] [Accepted: 09/03/2014] [Indexed: 11/21/2022]
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Acute retinal pigment epitheliitis: spectral domain optical coherence tomography, fluorescein angiography, and autofluorescence findings. Case Rep Med 2015; 2015:149497. [PMID: 25767511 PMCID: PMC4341849 DOI: 10.1155/2015/149497] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/01/2015] [Indexed: 11/18/2022] Open
Abstract
A 17-year-old presented with central and paracentral scotomas in his right eye for one week. There was no remarkable medical or ocular history. Blood analyses were within normal range. At presentation both eyes' best-corrected visual acuities were 20/20. Slit-lamp examination result was normal. Fundus examination revealed yellow-white hypopigmented areas in the macula. Fluorescein angiography (FA) showed hypofluorescence surrounded by ring of hyperfluorescence. Fundus autofluorescence (FAF) was slightly increased. Spectral domain optical coherence tomography (SD-OCT) showed disruption of IS/OS junction with expansion of abnormal hyperreflectivity from retinal pigment epithelium to the outer nuclear layer (ONL). One month later fundus examination showed disappearance of the lesions. FA revealed transmission hyperfluorescence. FAF showed increased autofluorescence and pigment clumping. Hyperreflective band in SD-OCT disappeared. Loss of photoreceptor segment layers was observed in some of the macular lesions. The diagnosis of acute retinal pigment epitheliitis can be challenging after disappearance of fundus findings. FA, FAF, and SD-OCT are important tests for diagnosis after resolution of the disease.
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Lee CS, Woo SJ, Kim YK, Hwang DJ, Kang HM, Kim H, Lee SC. Clinical and Spectral-Domain Optical Coherence Tomography Findings in Patients with Focal Choroidal Excavation. Ophthalmology 2014; 121:1029-35. [DOI: 10.1016/j.ophtha.2013.11.043] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/21/2013] [Accepted: 11/27/2013] [Indexed: 11/25/2022] Open
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Witkin AJ, Shah R, Garg SJ. Optical coherence tomography and fundus autofluorescence imaging in uveitis. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.12.79] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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TOMOGRAPHIC AND ANGIOGRAPHIC CHARACTERISTICS OF EYES WITH MACULAR FOCAL CHOROIDAL EXCAVATION. Retina 2013; 33:1201-10. [DOI: 10.1097/iae.0b013e31827b6452] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Diagnostic and Therapeutic Challenges. Retina 2013; 33:1081-5. [DOI: 10.1097/iae.0b013e318285f471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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B-scan and "en-face" spectral-domain optical coherence tomography imaging for the diagnosis and followup of acute retinal pigment epitheliitis. Case Rep Med 2013; 2013:260237. [PMID: 23476659 PMCID: PMC3588221 DOI: 10.1155/2013/260237] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/19/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose. To report B-scan and “En-face” spectral-domain optical coherence tomography (SD-OCT) findings in acute retinal pigment epitheliitis (ARPE). Methods. Two patients (3 eyes) with ARPE were examined. Fluorescein and indocyanine green (ICGA) angiography, B-scan, and “En-face” SD-OCT were performed in each patient at initial and follow-up visits. Results. Both patients presented with acute onset of blurred vision, and one with bilateral involvement. B-can OCT revealed disruption of the macular retinal pigment epithelial (RPE) inner band layer and photoreceptors' inner and outer segment (IS-OS) junction. Hyperreflective dots were observed in the outer nuclear layer (ONL) above the RPE/IS-OS disruption. Just around these hyperreflective dots, slight thickening of the hyperreflective IS/OS junction was observed. During the late phase, indocyanine green angiography (ICGA) showed a macular cockade-like hyperfluorescent halo. “En-face” OCT showed the same cockade-like appearance with a hyporeflective center and a hyperreflective border matching the pattern observed on ICGA. At followup, as vision improved without treatment, B-scan OCT demonstrated progressive resolution of the hyperreflective and disrupted lesions; “en-face” OCT also showed disappearance of the macular cockade-like halo with a transient discrete hyperreflective macular star at the RPE level in one eye.
Conclusion. “En-face” OCT associated with B-scan SD-OCT analysis appears to be very helpful in the diagnosis and followup of ARPE. The pathophysiology of ARPE remains complex and still poorly understood. These techniques help define the location and extent of structural damage occurring in this disease.
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Merkoudis N, Granstam E. Acute retinal pigment epitheliitis: optical coherence tomography findings at onset and follow-up. Acta Ophthalmol 2013; 91:e84-5. [PMID: 22682008 DOI: 10.1111/j.1755-3768.2012.02442.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gutiérrez-Montero O, Reche-Sainz JA, Rivera-Zori M. [Acute retinal pigment epitheliitis. Diagnosis using optical coherence tomography]. ACTA ACUST UNITED AC 2012; 89:58-61. [PMID: 24269384 DOI: 10.1016/j.oftal.2012.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 06/24/2012] [Indexed: 11/26/2022]
Abstract
CASE REPORT A 17 year-old female presented with a bilateral and acute visual loss. On ophthalmoscopic examination, there was a subfoveal deposit with a vitelliform appearance. Optical coherence tomography revealed a hyperreflective and homogeneous material located at the photoreceptor external segment layer. A month later, vision had spontaneously recovered and macular appearance was normalised. On tomography, the subretinal material had completely disappeared. DISCUSSION Acute retinal pigment epitheliitis is a rare condition that usually causes a transient visual loss, with a good prognosis in young subjects.
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Affiliation(s)
| | - J A Reche-Sainz
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.
| | - M Rivera-Zori
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
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SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN ACUTE RETINAL PIGMENT EPITHELIITIS. Retin Cases Brief Rep 2012; 6:309-12. [PMID: 25389741 DOI: 10.1097/icb.0b013e3182378bd7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cho HJ, Lee DW, Kim CG, Kim JW. Spectral domain optical coherence tomography findings in acute retinal pigment epitheliitis. Can J Ophthalmol 2011; 46:498-500. [PMID: 22153636 DOI: 10.1016/j.jcjo.2011.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 07/12/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report spectral domain optical coherence tomography (SD-OCT) findings in 3 patients with acute retinal pigment epitheliitis (ARPE). DESIGN Retrospective chart review. METHODS Charts of three young patients with ARPE were reviewed. RESULTS In acute stage, SD-OCT demonstrated abnormal hyperreflectivity involving the photoreceptor outer segment layer and hyporeflectivity involving the associated RPE layer in all cases. In chronic stage, SD-OCT showed decreased abnormal reflectivity. In one case with incomplete recovery of visual acuity, disruption of the photoreceptor inner and outer segment (IS/OS) junction was demonstrated in chronic phase. CONCLUSIONS SD-OCT confirmed that the outer segments of foveal photoreceptors and the associated RPE layer were the primary affected sites with ARPE. Detection of integrity of the foveal IS/OS line in resolved ARPE could be helpful in prediction of visual prognosis.
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Affiliation(s)
- Han Joo Cho
- Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea.
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Retinal fluorescein and indocyanine green angiography and spectral-domain optical coherence tomography findings in acute retinal pigment epitheliitis. Retina 2011; 31:1156-63. [PMID: 21293312 DOI: 10.1097/iae.0b013e3181fbcea5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the specific location of the initial lesion in acute retinal pigment epitheliitis. METHODS Four patients diagnosed with acute retinal pigment epitheliitis were studied. Fundus photographs, fluorescein angiography and indocyanine green angiography, and spectral-domain optical coherence tomography findings were reviewed. RESULTS Four healthy young patients presented with acute onset of unilateral decreased vision. Ophthalmoscopy showed macular pigment mottling with surrounding yellow hypopigmented areas at the level of the retinal pigment epithelium (RPE). Fluorescein angiography revealed transmission hyperfluorescence. Early-phase and midphase indocyanine green angiography images showed a patchy macular hyperfluorescence. At late phase of indocyanine green angiography, a hyperfluorescent halo with a cockadelike appearance of the macular area was observed. Spectral-domain optical coherence tomography showed a disruption of the photoreceptors' inner segment and outer segment interface associated with a wider disruption of the RPE inner band. These disrupted lines were replaced by a dome-shaped highly reflective lesion involving the RPE inner layer, the photoreceptors' inner segment and outer segment layers, and, in two cases, the outer nuclear layer. With time, indocyanine green angiography showed resolution of the observed lesions. Spectral-domain optical coherence tomography showed restored and continuous inner segment and outer segment layers and RPE inner band. CONCLUSION Spectral-domain optical coherence tomography findings suggest that the initial lesion in acute retinal pigment epitheliitis is located at the junction between the photoreceptor outer segments and the apical side of the RPE cells. Indocyanine green angiography and spectral-domain optical coherence tomography show that the RPE appears to be more widely involved than the neurosensory retina.
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Kim JW, Jang SY, Park TK, Ohn YH. Short-term clinical observation of acute retinal pigment epitheliitis using spectral-domain optical coherence tomography. KOREAN JOURNAL OF OPHTHALMOLOGY 2011; 25:222-4. [PMID: 21655052 PMCID: PMC3102830 DOI: 10.3341/kjo.2011.25.3.222] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 08/05/2010] [Indexed: 11/23/2022] Open
Abstract
We investigated the case of a young man with blurred vision in his left eye. His visual acuity was slightly decreased, and ophthalmoscopy disclosed a gray-white lesion in the macula. He had no systemic or ocular history. On the visual field test, the threshold sensitivity was decreased in the corresponding region. Spectral domain optical coherence tomography (OCT) demonstrated a disruption in the photoreceptor inner and outer segment (IS/OS) junction and undulation of the retinal pigment epithelium (RPE) with backscattering. We re-examined the patient after two weeks and after three months without any treatment. Visual acuity and visual field results were gradually normalized, and OCT demonstrated the recovery of continuity in the photoreceptor IS/OS junction, as well as decreased RPE irregularity with minimal backscattering. We used spectral domain OCT instead of time domain OCT (OCT3) so that we could provide better image resolution of the acute retinal pigment epitheliitis (ARPE). Finally, we observed recovery of the functional and anatomical changes in the ARPE patient with a resolution of the condition within three months following the initial examination, using OCT and visual field tests.
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Affiliation(s)
- Jee Wook Kim
- Department of Ophthalmology, Soonchunhyang University Hospital, Bucheon, Korea
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Abstract
PURPOSE To describe the morphologic appearance of the retina during the course of acute retinal pigment epitheliitis (ARPE) with optical coherence tomography (OCT). METHODS Observational case report. RESULTS OCT demonstrated an abnormality in the inner higher reflective line, which represents the outer and inner segments of the retinal photoreceptors at the fovea. Four months later, the tomographic appearance returned to normal. CONCLUSION Photoreceptors segments are involved in the disease process of ARPE. OCT demonstrated the different stages in the resolution of ARPE.
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Loh BK, Chee SP. Optical coherence tomography findings in acute retinal pigment epitheliitis. Am J Ophthalmol 2007; 143:1071; author reply 1071. [PMID: 17524791 DOI: 10.1016/j.ajo.2007.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 02/19/2007] [Accepted: 02/20/2007] [Indexed: 10/23/2022]
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