This patient has bilateral fundus findings consistent with resolved acute posterior multifocal placoid pigment epitheliopathy (APMPPE).
Triton fundus photos show placoid areas of atrophic pigmentary changes, which are variably hypo-autofluorescent.
Triton swept-source OCT in the right eye shows outer retinal atrophy with outer retinal tubulation (ORT) and nasal outer retinal atrophy in the left eye.
Learning Points:
ORT, initially described by Zweifel et al (Arch Ophthalmol 2009;127;1596-1602), is a neurodegenerative condition of the photoreceptors and Muller cells associated with atrophy affecting the outer retina and retinal pigment epithelium, including advanced AMD and inherited retinal diseases.
ORT is often seen overlying inactive macular neovascularization in the setting of ongoing anti-VEGF therapy and should not be confused with exudative fluid or cysts, which lack a hyperreflective border. The outer hyperreflective band likely represents inner segment mitochondria undergoing fission and translocation toward the nucleus (Litts et al, Retina 2018;38;445-461).
Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a usually bilateral inflammatory vs ischemic disorder of the inner choroid, RPE, and outer retina.
Blurry vision and paracentral/central scotomas often follow a viral illness. Acutely multifocal creamy yellow or grayish-white subretinal placoid lesions are scattered throughout the posterior poles. The lesions and visual symptoms usually resolve within 4 to 8 weeks with secondary chorioretinal changes. Recurrent lesions are rare, and vision is usually fairly good.
