Posterior and placoid - FFA and other investigations!


๐—”๐—ฃ๐— ๐—ฃ๐—ฃ๐—˜โฃ

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๐˜๐˜ฏ๐˜ท๐˜ฆ๐˜ด๐˜ต๐˜ช๐˜จ๐˜ข๐˜ต๐˜ช๐˜ฐ๐˜ฏ๐˜ดโฃ

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โ— ๐—™๐—น๐˜‚๐—ผ๐—ฟ๐—ฒ๐˜€๐—ฐ๐—ฒ๐—ถ๐—ป ๐—”๐—ป๐—ด๐—ถ๐—ผ๐—ด๐—ฟ๐—ฎ๐—บ (๐—™๐—”):โ€‹ ๐—˜๐—ฎ๐—ฟ๐—น๐˜† ๐—ต๐˜†๐—ฝ๐—ผ๐—ณ๐—น๐˜‚๐—ผ๐—ฟ๐—ฒ๐˜€๐—ฐ๐—ฒ๐—ป๐—ฐ๐—ฒ (๐—ฏ๐—น๐—ผ๐—ฐ๐—ธ๐—ฎ๐—ด๐—ฒ) ๐—ฐ๐—ผ๐—ฟ๐—ฟ๐—ฒ๐˜€๐—ฝ๐—ผ๐—ป๐—ฑ๐—ถ๐—ป๐—ด ๐˜๐—ผ ๐˜๐—ต๐—ฒ ๐—ฝ๐—น๐—ฎ๐—ฐ๐—ผ๐—ถ๐—ฑ ๐—น๐—ฒ๐˜€๐—ถ๐—ผ๐—ป๐˜€ ๐—ณ๐—ผ๐—น๐—น๐—ผ๐˜„๐—ฒ๐—ฑ ๐—ฏ๐˜† ๐—น๐—ฎ๐˜๐—ฒ, ๐—ถ๐—ฟ๐—ฟ๐—ฒ๐—ด๐˜‚๐—น๐—ฎ๐—ฟ ๐—ต๐˜†๐—ฝ๐—ฒ๐—ฟ๐—ณ๐—น๐˜‚๐—ผ๐—ฟ๐—ฒ๐—ฐ๐—ฒ๐—ป๐˜ ๐˜€๐˜๐—ฎ๐—ถ๐—ป๐—ถ๐—ป๐—ดโฃ




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โ— ๐˜๐˜ฏ๐˜ฅ๐˜ฐ๐˜ค๐˜บ๐˜ข๐˜ฏ๐˜ช๐˜ฏ๐˜ฆ ๐˜Ž๐˜ณ๐˜ฆ๐˜ฆ๐˜ฏ (๐˜๐˜Š๐˜Ž) ๐˜ˆ๐˜ฏ๐˜จ๐˜ช๐˜ฐ๐˜จ๐˜ณ๐˜ข๐˜ฎ:โ€‹ Early and late hypofluorescence corresponding to the placoid lesionsโฃ

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โ— ๐˜๐˜ถ๐˜ฏ๐˜ฅ๐˜ถ๐˜ด ๐˜ข๐˜ถ๐˜ต๐˜ฐ๐˜ง๐˜ญ๐˜ฐ๐˜ถ๐˜ณ๐˜ฆ๐˜ด๐˜ค๐˜ฆ๐˜ฏ๐˜ด๐˜ฆ (๐˜๐˜ˆ๐˜):โ€‹ Early and late hypoautoflourescence corresponding to the placoid lesions. Hypoautoflourescence may persist at borders after lesion resolutionโฃ

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โ— ๐˜–๐˜ฑ๐˜ต๐˜ช๐˜ค๐˜ข๐˜ญ ๐˜ค๐˜ฐ๐˜ฉ๐˜ฆ๐˜ณ๐˜ฆ๐˜ฏ๐˜ค๐˜ฆ ๐˜ต๐˜ฐ๐˜ฎ๐˜ฐ๐˜จ๐˜ณ๐˜ข๐˜ฑ๐˜ฉ๐˜บ (๐˜–๐˜Š๐˜›):โ€‹ Hyperreflectivity from the outer plexiform layer to the RPE with normal retinal thickness in acute lesions. Hyperreflectivity of outer layers resolve along with resolution of the lesion. โฃ

In some cases, subretinal fluid can be seen. โฃ

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โ— CNS imaging โ€‹should be performed to rule out CNS vasculitis in all patients with a new diagnosis of APMPPE.โฃ

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๐˜—๐˜ณ๐˜ฐ๐˜จ๐˜ฏ๐˜ฐ๐˜ด๐˜ช๐˜ด ๐˜ข๐˜ฏ๐˜ฅ ๐˜”๐˜ข๐˜ฏ๐˜ข๐˜จ๐˜ฆ๐˜ฎ๐˜ฆ๐˜ฏ๐˜ตโฃ

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โ— Usually self-limiting with good prognosisโฃ

โ— Risk factors for visual loss - foveal involvement at presentation, older age, unilateral disease, longer interval between initial and fellow eye involvement, recurrencesโฃ

โ— All patients with a new diagnosis of APMPPE should receive a full neurologic and systemic work-up to evaluate for CNS vasculitis and other associated systemic conditionsโฃ

โ— Role of steroids not fully understoodโฃ

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