Acute posterior multifocal placoid pigment epitheliopathy
Encyclopedia
Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) is a chorioretinal disease
in which light-coloured lesion
s begin to form in the posterior pole
and inside the retina
of the eye
. Over time, the lesions cause vision loss
that can go from mild to severe, but with no pain involved. Classified as an inflammatory disorder
that is acute
, but self-limiting, the lesions leave behind scarring, but visual acuity
eventually improves.
It occurs equally between genders, but is more likely to affect a person between the ages of 20 to 40. Also, it is known to occur after a systemic infection, showing that it is related generally to a depressed
immune system
. Recurrent episodes can happen if the infection was originally unilateral, with the second eye becoming infected even up to years after the initial infection, though most recurrences happen in less than six months.
from the eye, caused by the inflammation
. The distortion of vision and area of effect depends on the placement and number of lesions in the eye.
Eventually, the lesions begin to clear up and disappear, giving the eye a light, mottled shade. It is possible for mild scarring to appear and for choroidal neovascularization
to occur as late onset signs.
to a larger infection, or the possibility of it being viral
because of the preceding flu-like illness that generally accompanies it.
However, some side effects of the disease can be neurological, such as strokes, and different brain infections. These occurrences can start with mild headaches that steadily increase in pain and threshold and include attacks of dysesthesia
. It has been found that this type of deterioration happens usually if the lesions infect the fovea
.
There have been increasing reports of APMPPE having the effect of cerebrovascular damage
, including cerebral artery damage from inflammation. A considerable connection can be made between the infection and later cases of cerebral vasculitis
.
in which light-coloured lesion
Lesion
A lesion is any abnormality in the tissue of an organism , usually caused by disease or trauma. Lesion is derived from the Latin word laesio which means injury.- Types :...
s begin to form in the posterior pole
Posterior pole
In ophthalmology, the posterior pole is the back of the eye, usually referring to the retina between the optic disc and the macula....
and inside the retina
Retina
The vertebrate retina is a light-sensitive tissue lining the inner surface of the eye. The optics of the eye create an image of the visual world on the retina, which serves much the same function as the film in a camera. Light striking the retina initiates a cascade of chemical and electrical...
of the eye
Human eye
The human eye is an organ which reacts to light for several purposes. As a conscious sense organ, the eye allows vision. Rod and cone cells in the retina allow conscious light perception and vision including color differentiation and the perception of depth...
. Over time, the lesions cause vision loss
Vision loss
Vision loss or visual loss is the absence of vision where it existed before, which can happen either acutely or chronically .-Ranges of vision loss:...
that can go from mild to severe, but with no pain involved. Classified as an inflammatory disorder
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
that is acute
Acute (medicine)
In medicine, an acute disease is a disease with either or both of:# a rapid onset, as in acute infection# a short course ....
, but self-limiting, the lesions leave behind scarring, but visual acuity
Visual acuity
Visual acuity is acuteness or clearness of vision, which is dependent on the sharpness of the retinal focus within the eye and the sensitivity of the interpretative faculty of the brain....
eventually improves.
It occurs equally between genders, but is more likely to affect a person between the ages of 20 to 40. Also, it is known to occur after a systemic infection, showing that it is related generally to a depressed
Depression (physiology)
Depression in physiology and medicine refers to a lowering, in particular a reduction in a particular biological variable or the function of an organ...
immune system
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
. Recurrent episodes can happen if the infection was originally unilateral, with the second eye becoming infected even up to years after the initial infection, though most recurrences happen in less than six months.
Signs
The formation of multiple lesions is the only informative sign of the presence of the disease. These lesions may be colored from grey-white to a cream-shaded yellow. The edges of the lesions are indistinct and have no true pattern or formation, but are generally similar in size. Though it is possible for some adjacent lesions to join together and cover a larger, overall area. It is quite likely for there to be some sort of liquid dischargeMucopurulent discharge
Mucopurulent discharge is the emission or secretion of fluid containing mucus and pus from the eye, nose, cervix, vagina or other part of the body due to infection and inflammation....
from the eye, caused by the inflammation
Inflammation
Inflammation is part of the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. Inflammation is a protective attempt by the organism to remove the injurious stimuli and to initiate the healing process...
. The distortion of vision and area of effect depends on the placement and number of lesions in the eye.
Eventually, the lesions begin to clear up and disappear, giving the eye a light, mottled shade. It is possible for mild scarring to appear and for choroidal neovascularization
Choroidal neovascularization
Choroidal neovascularization is the creation of new blood vessels in the choroid layer of the eye. This is a common symptom of the degenerative maculopathy wet AMD .-Causes:...
to occur as late onset signs.
Symptoms
General symptoms include:- Blurred visionBlurred vision-Causes:There are many causes of blurred vision:* Use of atropine or other anticholinergics* Presbyopia -- Difficulty focusing on objects that are close. The elderly are common victims....
- Scotomas
- PhotopsiaPhotopsiaPhotopsia is the presence of perceived flashes of light. It is most commonly associated with posterior vitreous detachment, migraine with aura, migraine aura without headache, retinal break or detachment, occipital lobe infarction and sensory deprivation...
- Metamorphopsia
Etiology
The origin of the infection remains unknown, with various theories of it occurring as an immune responseImmune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
to a larger infection, or the possibility of it being viral
Virus
A virus is a small infectious agent that can replicate only inside the living cells of organisms. Viruses infect all types of organisms, from animals and plants to bacteria and archaea...
because of the preceding flu-like illness that generally accompanies it.
Aftereffects
While vision does improve in almost all cases, it is rare that a person recovers complete eyesight. Often, eyesight remains impaired by having a lower acuity than previously and some of the symptoms can remain indefinitely. Long-term diagnosis is good for most cases, but with more than half reporting some visual disturbance in the center of the eye.However, some side effects of the disease can be neurological, such as strokes, and different brain infections. These occurrences can start with mild headaches that steadily increase in pain and threshold and include attacks of dysesthesia
Dysesthesia
Dysesthesia comes from the Greek word "dys", meaning "not-normal" and "aesthesis", which means "sensation" . It is defined as an unpleasant, abnormal sense of touch, and it may be, or not be, considered as a kind of pain...
. It has been found that this type of deterioration happens usually if the lesions infect the fovea
Fovea
The fovea centralis, also generally known as the fovea , is a part of the eye, located in the center of the macula region of the retina....
.
There have been increasing reports of APMPPE having the effect of cerebrovascular damage
Cerebrovascular disease
Cerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels supplying the brain. Hypertension is the most important cause; it damages the blood vessel lining, endothelium, exposing the underlying collagen where platelets aggregate to initiate a repairing process...
, including cerebral artery damage from inflammation. A considerable connection can be made between the infection and later cases of cerebral vasculitis
Cerebral vasculitis
Cerebral vasculitis or central nervous system vasculitis is vasculitis involving the brain and occasionally the spinal cord...
.