Patient Presentation: A 23-year-old obese female was diagnosed with idiopathic intracranial hypertension (IIH) and referred to neurosurgery for ventriculoperitoneal shunt. A baseline ocular examination was performed prior to the procedure.

On examination, vision was 20/200 in the right eye, and 20/40 in the left eye. There was a right relative afferent pupillary defect. Slit lamp examination was normal.

A dilated fundus examination was performed demonstrating the following:

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Uveitis

Case 1

Contributors: Dr. John Liu, Dr. Irfan Kherani, Dr. Chloe Gottlieb

Patient Presentation: A 31-year-old female presents with a 1-week history of sudden, painless, bilateral blurred vision with central scotomas, worse in her right eye. Two weeks prior, she experienced flu-like symptoms, which have now resolved. On fundus exam, there are creamy grey-white placoid lesions at the level of the retinal pigment epithelium (RPE) in the posterior pole.

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Question: The patient's OCT is shown above. What abnormalities do you visualize in the patient's OCT image?

A. Hyperreflectivity from the outer plexiform layer to the RPE and subretinal fluid

B. Retinoschisis

C. Loss of the RPE and choriocapillaris

D. Epiretinal membrane

Question: What is the diagnosis?

A. Relentless placoid choroiditis

B. Syphilitic uveitis

C. Acute posterior multifocal placoid pigment epitheliopathy

D. Multiple evanescent white dot syndrome

Question: If this is her first presentation, what other systemic conditions should this patient be worked up for?

A. Carotid artery stenosis

B. CNS vasculitis

C. Amyotrophic lateral sclerosis

Learning Objectives:

1. Identify OCT features of acute posterior multifocal placoid pigment epitheliopathy (APMPPE)

2. Recognize associations of APMPPE with other systemic conditions