Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) Medication

Updated: May 03, 2017
  • Author: Lakshmana M Kooragayala, MD; Chief Editor: C Stephen Foster, MD, FACS, FACR, FAAO, FARVO  more...
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Medication

Medication Summary

In most cases, the lesions of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) 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.

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Corticosteroids

Class Summary

Suppress ocular and systemic inflammation.

Prednisone (Deltasone, Rayos)

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.

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Vascular Endothelial Growth Factor Inhibitors

Class Summary

These agents slow vision loss by suppressing neovascularization.

Bevacizumab (Avastin)

Off-label indication for choroidal neovascularization.

Off-label: 1.25 mg (in 0.05 mL of solution) administered via intravitreal injection once monthly or as needed.

The need to repackage the drug from the available size vial into smaller doses increases risk for infection transmission if improper aseptic technique occurs.

Ranibizumab (Lucentis)

Off-label use for choroidal neovascularization

0.5 mg intravitreal injection monthly or as needed

Aflibercept intravitreal (Eylea)

Off-label use for choroidal neovascularization

2 mg (0.05 mL) via intravitreal injection monthly or as needed.

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Immunosuppressants

Class Summary

These agents inhibit inflammatory reactions by suppressing key factors of the immune system.

Infliximab (Remicade)

Off-label use for cases with severe systemic manifestations.

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