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Introduction
Krill and Deutmann (1) described acute retinal pigment
epithelitis in 1972. Acute retinal pigment epithelitis is a rare,
idiopathic and self-limiting benign inflammatory disorder of
retinal pigment epithelium in macular area. Although the
effective treatment is unknown there is excellent prognosis for
visual recovery. In 75% of cases the disease is unilateral,
without any signs or symptoms of intraocular inflammation. At
the time of diagnosis patients are usually in their 3th – 5th
decade of life. The condition is characterised by suddenly
diminished central vision, occasionally associated with
metamorphopsia (2). We present a case of 18 years old patient
with typical signs of ARPE.
Case report
18 years old woman was examined by ophthalmologist at the
beginning of July 2005, for suddenly decreased vision and dark
spot in visual field of her left eye. There was no history of
trauma, systemic disorders and prior ocular complaints. Family
history was not significant. First examination showed BCVA 1.0
cc –0.25 D (in right eye) and 0.1 ( in left eye, no improvement
with glasses,). There was central scotoma in Amsler grid test in
left eye. Eyelids and anterior segment as well as intraocular
pressure were normal in both eyes. Fundus examination of the
right eye was normal and of the left eye revealed discrete, tiny
aggregations of small brown dots at the level of retinal pigment
epithelium (RPE), surrounded by oval and yellow hypopigmented „
halo”.
The fluoresceine angiography and OCT were performed. The
fluoresceine angiogram (FA) showed small areas of
hyperfluorescence with hypofluorescence in the centre, with no
evidence of leakage.
The RPE-layer in OCT was significantly thicker and irregular.
Scotopic and photopic ERG were normal. The ARPE was diagnosed
and therefore no treatment was prescribed and follow-up visits
were scheduled. On the next follow-up visit patient reported
slow improvement of visual acuity and brightening of the dark
spot in visual field of left eye. At the last visit, at the end
of October 2005 (4 months after initial symptoms), BCVA in left
eye was 0.9 cc 1.0 Dsph. There was a relative scotoma in Amsler
grid test of left eye. The results of ophthalmoscopy and FA did
not changed. There was a partial resolution of changes in OCT.
The RPE layer in OCT in the foveal area was thinner and in the
rest of the macula more regular.
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Discussion
ARPE is a rarely reported eye disorder, usually diagnosed in
3th-5th decade. In our patient it was seen in 2 decade. The
etiology of ARPE remains unknown. Although some authors suggest
it may have viral etiology 3, up to this time this correlation
was not clearly shown. Prior to onset of the disease our patient
was completely healthy, without any complaints suggesting the
viral origin of the eye disease. Many authors have suggested a
correlation between ARPE and central serous chorioretinopathy (CSCR)
4, 5. Our patient was observed by ophthalmologist for 5 months
and no signs of CSCR were disclosed. Maybe later in the course
of the observation some changes characteristic for CSCR will
appear. During follow-up we could observe improvement in visual
symptoms (visual acuity and central visual field defect in
Amsler grid test). Improvement noticed by the patient was well
documented by improvement in OCT scans. The RPE layer in OCT in
the fovea was thinner and in the rest of the macula more regular
after 4 month from initial examination. In our opinion OCT is a
very useful method of monitoring changes of retinal pigment
epithelium. During follow-up we did not observe any change of
the macular lesions in fundoscopy and of the results of FA.
References:
1. Krill AE, Deutman AF: Acute retinal pigment epitheliitis.
Am J Ophthalmol 1972, 74, 193.
2 Kański JJ: Clinical Ophthalmology. A Systematic Approach.
Wrocław: Górnicki Wydawnictwo Medyczne, 2005, 316.
3. Deutman AF: Acute retinal pigment epitheliitis. Am J
Ophthalmol 1974, 78, 571-578.
4. Piermarocchi S, Corradini R, Midena E, Segato T: Correlation
between retinal pigment epitheliitis and central serous
chorioretinopathy. Ann Ophthalmol 1983, 15, 425-428.
5. Eifrig DE, Knobloch WH, Moran JA: Retinal Pigment
Epitheliitis. Ann Ophthalmol 1977, 5, 640-642.
XXVIII Sympozjon Retinologiczny, PTO, Poznań
12-14.04.2007 r.
Praca wpłynęła do Redakcji 19.02.2007 r. (934)
Zawalifikowano d druku 25.03.2007 r.
Adres do korespondencji (Reprint requests to):
dr n. med. Anna Gotz-Więckowska
ul. Długa 1/2, 61-848 Poznań
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