Acute Posterior Multifocal Placoid Pigment Epitheliopathy: Clinical Presentation and Risk of Stroke and Transient Ischaemic Attack
Purpose
The primary objective was to determine the incidence of neurologic complications and risk factors for stroke and transient ischaemic attack associated with acute posterior multifocal placoid pigment epitheliopathy. Secondary objectives included the clinical presentation, visual outcomes and recurrence rates
Methods
Design: Multicenter retrospective case series.
Methods:
Setting: Multicenter hospital-based study
Patient or Study Population: 111 eyes from 60 subjects presenting with acute posterior multifocal placoid pigment epitheliopathy from January 2009 to June 2020.
Intervention or Observation Procedure: Retrospective analysis and chart review
Main Outcome Measures: Risk factors for stroke and transient ischaemic attack and incidence.
Results
Results: Median age at presentation was 29.0 years (IQR 24.7 – 35.1) and 36 subjects (60.0%) were male. 20 subjects (33.3%) reported a viral prodrome. Stroke and transient ischaemic attack were observed in 7 subjects (11.7%). Older age was the only significant risk factor for stroke/transient ischaemic attack (P=0.042). Vision loss occurred in seven eyes, with four eyes (3.6%) having final visual acuity 20/50-20/200 and three eyes (2.7%) ≤20/200. Recurrence occurred in ten subjects (16.7%).
Conclusion
The presence of headache cannot reliably predict those at risk of stroke/transient ischaemic attack. Individuals presenting with acute posterior multifocal pigment epitheliopathy should therefore undergo a neurologic review and work-up for cerebral vasculitis as deemed appropriate by the treating ophthalmologist and collaborating neurologist.
Conflict of interest
No
Authors 1
Last name
SAMALIA
Initials of first name(s)
PD
Department
Ophthalmology
City
Christchurch
Country
New Zealand
Authors 2
Last name
Niederer
Initials of first name(s)
RL
Department
Auckland District Health Board,
City
Auckland
Country
New Zealand
Authors 3
Last name
Chen
Initials of first name(s)
Y-H
Department
Department of Ophthalmology, Chang Gung Memorial Hospital
City
Taoyuan
Country
Taiwan
Authors 4
Last name
Cornish
Initials of first name(s)
EE
Department
Save Sight Institute
City
Sydney
Country
Australia
Authors 5
Last name
Guest
Initials of first name(s)
S
Department
Waikato District Health Board
City
Hamilton
Country
New Zealand
Authors 6
Last name
McCluskey
Initials of first name(s)
P
Department
Save Sight Institute
City
Sydney
Country
Australia
Authors 7
Last name
Lim
Initials of first name(s)
LL
Department
Royal Victorian Eye and Ear Hospital
City
Melbourne
Country
Australia
Authors 8
Last name
Sims
Initials of first name(s)
JL
Department
Auckland District Health Board
City
Auckland
Country
New Zealand
Authors 9
Last name
Lightman
Initials of first name(s)
S
Department
Moorfields Eye Hospital
City
London
Country
United Kingdom
Authors 10
Last name
Tomkins-Netzer
Initials of first name(s)
O
Department
Department of Ophthalmology
City
Haifa
Country
Israel
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