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25-year-old man was seen in the office on August 24, 2012. Starting about one and half weeks ago he woke up with night chills. He had a cold. He never took his temperature. He is not sure whether he had a fever. Also around that time his joints started hurting him, specifically his elbows, knees and ankles. He also has headaches, although the headache at this point is not severe, it is actually a little less than his usual headache and does not appear to be escalating. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision. They are a little bit off to the side. VISUAL ACUITY: OD 20/32, OS 20/32. IOP: 16 OU. SLIT EXAMINATION: There is 1+ cell and flare of the anterior chamber in both eyes with clear lenses. There are no iris nodules. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation and 1+ vitreous cells. There are some splotchy white geographic areas in the posterior pole. OS: Vertical C/D ratio is 0.2. There is no posterior vitreous separation. There are 1+ vitreous cells. Again, there are splotchy white geographic areas in the posterior pole. In neither eye do the white spots involve the center of the macula. FUNDUS PHOTOGRAPHY - AUTO FLUORESCENCE: The image in the left eye shows patches of hyper auto fluorescence corresponding to the areas of involvement. FUNDUS PHOTOGRAPHY - INFRA RED: The image shows very little change, it is nearly normal. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows as you would expect, early hypofluorescence corresponding to the lesions and they are more visible on the fluorescein angiogram than they are funduscopically. In the later frames the lesions stain fairly uniformly throughout the center of them and there is even a little bit of leakage possibly associated with them. The left eye similarly shows early blocking and late staining. INDOCYANINE GREEN ANGIOGRAPHY: The indocyanine green angiogram, which was shot out to fifteen minutes shows dense geographic blocking of the indocyanine green in the geographic areas. There are many more spots visible on indocyanine green angiogram than there are either on funduscopic or on fluorescein angiogram. SPECTRALIS-SD-OCT SCAN: The OCT scan of the right eye shows the lesions to be predominately in the deep retina. There is clear loss of the photoreceptor integrity. The pigment epithelium looks normal in the area of the lesions, but above that the photoreceptor outer segments all the way up to the external limiting membrane lose their normal architecture and in some areas where the lesions are a little bit fresher, it looks like there is loss of the entire outer segment of the photoreceptors with only preservation of the nuclei. There is no evidence of any serous retinal detachment in either eye. The left eye similarly on the OCT scan shows over the lesion again a loss of photoreceptor integrity. There does appear to be a little bit of pigment epithelial irregularity over the dense lesion inferior to the fovea. The involvement goes all the way from the outer plexiform layer out to the retinal pigment epithelium. The edges of the lesions are sharp and no evidence of any spreading around them.

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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color1155 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color674 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color540 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color744 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color621 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color551 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Photo - Color392 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photo459 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photo452 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photo424 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - InfraRed Photo445 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescence609 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescence514 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescence557 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fundus Autofluorescence568 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Red Free Photo451 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_17.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Red Free422 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram671 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_19.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram488 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram514 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_21.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram458 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_22.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram372 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_23.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram416 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_24.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram459 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram534 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_26.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram465 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_27.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram553 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_28.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram516 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_29.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram370 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_30.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram381 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_31.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram439 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_32.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram497 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_33.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram485 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_34.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram433 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram359 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram346 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_37.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram534 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_38.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram346 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_39.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Fluorescein Angiogram541 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_40.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram379 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_41.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram416 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_42.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram414 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_43.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram360 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_44.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram423 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_45.avi
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - OCT video takes TIME to load448 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_46.avi
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - OCT Video - Takes TIME to load512 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_47.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 487 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_48.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 840 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
APMPPE_rofe_49.jpg
Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 830 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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(0 votes)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - SD-OCT 988 views 25-year-old man with one and half weeks ago he woke up with night chills. Also around that time his joints started hurting him. He also has headaches, although the headache at this point is not severe. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision.
VISUAL ACUITY: OD 20/32, OS 20/32
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Sequential color photos show progression666 viewsVision in right eye dropped to 5/200 by the last photo.00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Sequential color photos show progression568 viewsVision in right eye dropped to 5/200 by the last photo.00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset301 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset237 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset254 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset286 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset223 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset228 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset242 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset219 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset211 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset222 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset192 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset240 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset220 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset206 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset185 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset200 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - 4 years after onset290 views4 years after presentation - vision 20/80 OD 20/16 OS and there is subretinal fibrosis00000
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25-year-old man was seen in the office on August 24, 2012. Starting about one and half weeks ago he woke up with night chills. He had a cold. He never took his temperature. He is not sure whether he had a fever. Also around that time his joints started hurting him, specifically his elbows, knees and ankles. He also has headaches, although the headache at this point is not severe, it is actually a little less than his usual headache and does not appear to be escalating. His vision has been changing for about the last week and a half. He sees some spots in his vision and they are blurred spots. They are not in the central vision. They are a little bit off to the side. VISUAL ACUITY: OD 20/32, OS 20/32. IOP: 16 OU. SLIT EXAMINATION: There is 1+ cell and flare of the anterior chamber in both eyes with clear lenses. There are no iris nodules. EXTENDED OPHTHALMOSCOPY: OD: Vertical C/D ratio is 0.2. There is no posterior vitreous separation and 1+ vitreous cells. There are some splotchy white geographic areas in the posterior pole. OS: Vertical C/D ratio is 0.2. There is no posterior vitreous separation. There are 1+ vitreous cells. Again, there are splotchy white geographic areas in the posterior pole. In neither eye do the white spots involve the center of the macula. FUNDUS PHOTOGRAPHY - AUTO FLUORESCENCE: The image in the left eye shows patches of hyper auto fluorescence corresponding to the areas of involvement. FUNDUS PHOTOGRAPHY - INFRA RED: The image shows very little change, it is nearly normal. FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows as you would expect, early hypofluorescence corresponding to the lesions and they are more visible on the fluorescein angiogram than they are funduscopically. In the later frames the lesions stain fairly uniformly throughout the center of them and there is even a little bit of leakage possibly associated with them. The left eye similarly shows early blocking and late staining. INDOCYANINE GREEN ANGIOGRAPHY: The indocyanine green angiogram, which was shot out to fifteen minutes shows dense geographic blocking of the indocyanine green in the geographic areas. There are many more spots visible on indocyanine green angiogram than there are either on funduscopic or on fluorescein angiogram. SPECTRALIS-SD-OCT SCAN: The OCT scan of the right eye shows the lesions to be predominately in the deep retina. There is clear loss of the photoreceptor integrity. The pigment epithelium looks normal in the area of the lesions, but above that the photoreceptor outer segments all the way up to the external limiting membrane lose their normal architecture and in some areas where the lesions are a little bit fresher, it looks like there is loss of the entire outer segment of the photoreceptors with only preservation of the nuclei. There is no evidence of any serous retinal detachment in either eye. The left eye similarly on the OCT scan shows over the lesion again a loss of photoreceptor integrity. There does appear to be a little bit of pigment epithelial irregularity over the dense lesion inferior to the fovea. The involvement goes all the way from the outer plexiform layer out to the retinal pigment epithelium. The edges of the lesions are sharp and no evidence of any spreading around them.