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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 - Color1136 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 - Color657 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 - Color520 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 - Color727 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 - Color603 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 - Color532 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 - Color379 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 Photo441 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 Photo436 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 Photo409 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 Photo412 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 Autofluorescence584 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 Autofluorescence486 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 Autofluorescence535 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 Autofluorescence538 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 Photo433 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 Free407 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 Angiogram654 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 Angiogram471 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 Angiogram496 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 Angiogram440 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 Angiogram352 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 Angiogram401 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 Angiogram438 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 Angiogram492 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 Angiogram447 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 Angiogram533 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 Angiogram498 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 Angiogram353 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 Angiogram367 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 Angiogram415 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 Angiogram477 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 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)
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Acute Posterior Multifocal Placoid Pigment Epitheliopathy - APMPPE - Indocyanine Green Angiogram417 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 Angiogram340 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 Angiogram332 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 Angiogram512 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 Angiogram330 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 Angiogram525 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 Angiogram364 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 Angiogram399 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 Angiogram397 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 Angiogram342 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 Angiogram406 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 load428 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 load493 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 462 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 819 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 795 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 967 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 progression647 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 progression553 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 onset284 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 onset239 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 onset271 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 onset209 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 onset212 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 onset224 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 onset204 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 onset193 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 onset209 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 onset173 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 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 onset191 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 onset171 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 onset187 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 onset267 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.