eMedicine Specialties > Ophthalmology > Retina
Acute Multifocal Placoid Pigment Epitheliopathy: Treatment & Medication
Updated: May 26, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
The treatment of APMPPE is somewhat controversial; however, the consensus is that no treatment seems to alter the course of the ocular lesions. The fundus lesions appear to run a relatively short self-limited course, which probably results from a one-time insult to the capillaries comprising the choroidal lobules.
Surgical Care
In cases complicated by subretinal neovascularization, laser photocoagulation may be useful.
Consultations
Consultations may be indicated if the diagnosis is not clear or if a systemic manifestation indicates such a need (an infrequent occurrence).
- Neurologist/neurosurgeon - CNS symptoms
- Urologist - Urinalysis findings
- Dermatologist - Skin findings
- Rheumatologist - Serum immunologic abnormalities
- Infectious disease specialist
Diet
No dietary restrictions are indicated.
Activity
No limitations of visual or physical activities are indicated unless systemic manifestations impose limitation of physical activities.
Medication
In most cases, the lesions resolve spontaneously, and no therapy is required. Some authors have used corticosteroids to treat the ocular disease and/or any severe systemic manifestations. However, there is no evidence that treatment with corticosteroids affects the visual outcome in patients with APMPPE. Various routes of administration (eg, topical, oral, pulse intravenous, sub-Tenon injection) and dosages of corticosteroids have been used. Cycloplegics may be useful for severe iritis, an infrequent finding.
Corticosteroids
Suppress ocular and systemic inflammation.
Prednisone (Deltasone, Orasone, Meticorten)
May be indicated when signs of systemic vasculitis are present, given either orally or by pulse IV therapy. May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.
Adult
Initially, 40-60 mg/d PO in single or divided dose, taper as indicated; up to 1 g methylprednisolone infused in solution over half-hour period; topically, 1 gtt up to qh while awake
Pediatric
Up to 2 mg/kg/d PO, depending upon indication and severity
Coadministration with estrogens may decrease prednisone clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics
Documented hypersensitivity; microbial infection (particularly tuberculosis); peptic ulcer disease; hepatic dysfunction; use with caution in patients with diabetes, hypertension, congestive heart failure, and renal failure
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur with glucocorticoid use
More on Acute Multifocal Placoid Pigment Epitheliopathy |
| Overview: Acute Multifocal Placoid Pigment Epitheliopathy |
| Differential Diagnoses & Workup: Acute Multifocal Placoid Pigment Epitheliopathy |
Treatment & Medication: Acute Multifocal Placoid Pigment Epitheliopathy |
| Follow-up: Acute Multifocal Placoid Pigment Epitheliopathy |
| Multimedia: Acute Multifocal Placoid Pigment Epitheliopathy |
| References |
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References
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Bugnone AN, Hartker F, Shapiro M, Pineless HS, Velez G. Acute and chronic brain infarcts on MR imaging in a 20-year-old woman with acute posterior multifocal placoid pigment epitheliopathy. AJNR Am J Neuroradiol. Jan 2006;27(1):67-9. [Medline]. [Full Text].
Di Crecchio L, Parodi MB, Saviano S, Ravalico G. Acute posterior multifocal placoid pigment epitheliopathy and ulcerative colitis: a possible association. Acta Ophthalmol Scand. Jun 2001;79(3):319-21. [Medline].
Howe LJ, Woon H, Graham EM, Fitzke F, Bhandari A, Marshall J. Choroidal hypoperfusion in acute posterior multifocal placoid pigment epitheliopathy. An indocyanine green angiography study. Ophthalmology. May 1995;102(5):790-8. [Medline].
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Scheufele TA, Witkin AJ, Schocket LS, Rogers AH, Schuman JS, Ko TH, et al. Photoreceptor atrophy in acute posterior multifocal placoid pigment epitheliopathy demonstrated by optical coherence tomography. Retina. Dec 2005;25(8):1109-12. [Medline]. [Full Text].
Smith CH, Savino PJ, Beck RW, Schatz NJ, Sergott RC. Acute posterior multifocal placoid pigment epitheliopathy and cerebral vasculitis. Arch Neurol. Jan 1983;40(1):48-50. [Medline].
Thomson SP, Roxburgh ST. Acute posterior multifocal placoid pigment epitheliopathy associated with adenovirus infection. Eye. May 2003;17(4):542-4. [Medline].
Uthman I, Najjar DM, Kanj SS, Bashshur Z. Anticardiolipin antibodies in acute multifocal posterior placoid pigment epitheliopathy. Ann Rheum Dis. Jul 2003;62(7):687-8. [Medline].
Wolf MD, Folk JC, Panknen CA, Goeken NE. HLA-B7 and HLA-DR2 antigens and acute posterior multifocal placoid pigment epitheliopathy. Arch Ophthalmol. May 1990;108(5):698-700. [Medline].
Yang DS, Hilford DJ, Conrad D. Acute posterior multifocal placoid pigment epitheliopathy after meningococcal C conjugate vaccine. Clin Experiment Ophthalmol. Apr 2005;33(2):219-21. [Medline].
Further Reading
Keywords
acute posterior multifocal placoid pigment epitheliopathy, APMPPE, acute multifocal posterior placoid pigment epitheliopathy, AMPPPE, AMPPE, acute placoid pigment epitheliopathy
Treatment & Medication: Acute Multifocal Placoid Pigment Epitheliopathy