Clinical and Imaging Features Aiding the Differentiation of Acute Posterior Multifocal Placoid Pigmented Epitheliopathy from Other Placoid Diseases.

Purpose: To describe clinical and multimodal imaging features of patients with Acute Posterior Multifocal Placoid Pigmented Epitheliopathy (APMPPE) and identify distinctive characteristics guiding in the differentiation between APMPPE and other placoid conditions (non-APMPPE).

Methods: Retrospective single-center observational study of all patients diagnosed with APMPPE in the Uveitis Service of Moorfields Eye Hospital between 2002 and 2022.

Results: Sixty patients with presumed APMPPE at presentation were included, of whom 37 had a confirmed diagnosis of APMPPE, and 23 received a different diagnosis (non-APMPPE) during the follow-up. Non-APMPPE included ampiginous choroiditis (6 patients), idiopathic multifocal choroiditis (5 patients), tubercular multifocal choroiditis (5 patients), serpiginous choroiditis (1 patient), tubercular serpiginous-like choroiditis (3 patients), sarcoidosis (2 patients) and persistent placoid maculopathy (1 patient). Compared to non-APMPPE, APMPPE was more commonly observed in individuals of white ethnicity (p = 0.025), had shorter duration of symptoms (11.3 days, p = 0.02) and was associated with a viral prodrome (p < 0.001). APMPPE course was more commonly non-relapsing compared to non-APMPPE (p = 0.02), although relapses were observed in 18.9% of APMPPE cases. Mean final BCVA was significantly better in the APMPPE group (p = 0.04). Subfoveal choroidal thickness at presentation and final visit was significantly greater in APMPPE compared to non-APMPPE (p < 0.001), both in the eyes affected and fellow eyes that became affected later.

Conclusions: In addition to the established clinical features and multimodal imaging characteristics, ethnicity, duration of symptoms, viral prodrome and subfoveal choroidal thickness can add useful information in guiding physicians in differentiating APMPPE from other mimicking placoid conditions.