Macular Neovascular Membrane as a Late Complication of Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) Managed With Intravitreal Aflibercept.

Abstract

Purpose: To report a case of a macular neovascular membrane (MNV) 14 years after an episode of acute posterior multifocal placoid pigment epitheliopathy (APMPPE).

Methods: Case report.

Results: A 22-year-old man presented with acute bilateral blurred vision. The best corrected visual acuity (VA) was 20/200 in both eyes. Fundus examination revealed bilateral multiple yellow-gray placoid lesions and macular serous detachments. Multimodal imaging and a systemic workup excluded systemic inflammatory or infectious diseases, confirming the diagnosis of APMPPE. The patient was treated with triamcinolone acetonide, an intravitreal injection in the right eye, and a posterior subtenon injection in the left eye. At the 8-week follow-up, the fundus lesions healed, with resolution of the macular serous detachment in both eyes. The VA improved to 20/63 bilaterally. After being lost to follow-up for 14 years, the patient presented sudden worsening of vision in the left eye. The VA decreased to 20/400 in the left eye due to an extensive subretinal hemorrhage and hard exudates in the macula. After diagnostic confirmation of a Type 2 MNV by optical coherence tomography angiography, the patient was treated with three monthly intravitreal injections of aflibercept. The VA improved to 20/160 a month after the treatment.

Conclusion: The treatment with aflibercept in this rare case of MNV secondary to APMPPE effectively controlled membrane activity. However, the fibrosis and atrophy resulting from the MNV contributed to only a partial recovery of VA. Long-term follow-up of patients with APMPPE is recommended for early detection and treatment of possible MNV development to improve functional outcomes.