A syndrome resembling acute posterior multifocal placoid pigment epitheliopathy in older adults.

Purpose: To describe clinical characteristics and visual and anatomic outcomes of a syndrome clinically similar to acute posterior multifocal placoid pigment epitheliopathy (APMPPE) in older patients.

Methods: We retrospectively reviewed medical records and photographic studies of consecutive patients over the age of 50 who presented to an academic tertiary care center with acute-onset visual symptoms associated with flat, gray-white lesions at the level of the retinal pigment epithelium reminiscent of APMPPE. Main outcome measures were visual acuity and macular anatomic status at the final follow-up visit.

Results: The cohort included 4 men and 2 women with a median age of 72.5 (range, 58-82) years. The disease course was characterized by recurrent episodes in 6 of 11 eyes (55%), with initial or eventual bilaterality in all 5 binocular patients. Five of 6 patients were treated with corticosteroids, and all 6 patients experienced significant short-term improvement in visual acuity. However, 8 of 11 eyes (73%) developed progressive geographic atrophy, and 7 (64%) developed choroidal neovascularization. With a mean (+/- SD) follow-up time of 6.6 +/- 5.5 years, the final visual acuity was 20/200 or worse in 8 of 11 eyes (73%).

Conclusions: Although older patients presenting with APMPPE-like lesions are likely to experience visual improvement as acute lesions resolve, progression to geographic atrophy and choroidal neovascular membrane formation is the usual long-term outcome.