Indocyanine green angiography of acute posterior multifocal placoid pigment epitheliopathy

We performed indocyanine green angiography (IA) and fluorescein angiography (FA) in following the course of a 24-year-old male with acute posterior multifocal placoid pigment epitheliopathy (APMPPE). The placoid lesions showed marked choroidal hypofluorescence in early phase FA and became hyperfluorescent in the late phase, in contrast to IA, in which hypofluorescence continued from the early to late phase, with large choroidal vessel disruption along the way. The healed lesions in IA appeared similar to the acute ones, but the areas with hyperfluorescence in FA and marked hypofluorescence in IA degenerated to chorioretinal atrophy. These results suggest that once the choriocapillaris is occluded it never reperfuses, and that APMPPE is caused by occlusion of the choriocapillaris, and possibly by partial occlusion of large choroidal vessels.