Short communication
Acute retinal pigment epitheliitis (ARPE). A case report
Epitelitis pigmentaria retiniana aguda (EPRA). A propósito de un caso
A.B. González Escobar
, A. Ibáñez García, A. Chinchurreta Capote, S. Gismero Moreno, M. Lorenzo Soto
Corresponding author
Hospital Costa del Sol, Málaga, Spain
Read
1
Timeswas read the article
0
Total PDF
1
Total HTML
Share statistics
array:24 [ "pii" => "S2173579421001614" "issn" => "21735794" "doi" => "10.1016/j.oftale.2021.10.001" "estado" => "S300" "fechaPublicacion" => "2022-04-01" "aid" => "1884" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2020" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2022;97:230-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669120304895" "issn" => "03656691" "doi" => "10.1016/j.oftal.2020.11.019" "estado" => "S300" "fechaPublicacion" => "2022-04-01" "aid" => "1884" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2022;97:230-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comunicación corta</span>" "titulo" => "Epitelitis pigmentaria retiniana aguda (EPRA). A propósito de un caso" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "230" "paginaFinal" => "233" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Acute retinal pigment epitheliitis (ARPE). A case report" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 586 "Ancho" => 1500 "Tamanyo" => 92028 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Retinografías mostrando la lesión amarillenta de aspecto viteliforme subfoveal en el ojo izquierdo.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.B. González Escobar, A. Ibáñez García, A. Chinchurreta Capote, S. Gismero Moreno, M. Lorenzo Soto" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A.B." "apellidos" => "González Escobar" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Ibáñez García" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Chinchurreta Capote" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Gismero Moreno" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Lorenzo Soto" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579421001614" "doi" => "10.1016/j.oftale.2021.10.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579421001614?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120304895?idApp=UINPBA00004N" "url" => "/03656691/0000009700000004/v1_202204070553/S0365669120304895/v1_202204070553/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579421001602" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.11.015" "estado" => "S300" "fechaPublicacion" => "2022-04-01" "aid" => "1883" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2022;97:234-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Bilateral neurosensory retinal detachment secondary to tadalafil treatment" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "234" "paginaFinal" => "238" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Desprendimiento neurosensorial retiniano bilateral secundario a tratamiento con tadalafilo" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1264 "Ancho" => 3333 "Tamanyo" => 509394 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) OCT findings at the time of diagnosis. Peripapillary NSD in the papillomacular bundle in RE and superior nasal in LE. Serous detachment in macular OCT of the RE (arrows). (B) Changes three months after drug withdrawal. Resolution of serous detachment with persistence of changes in the RPE and the ellipsoid line in macular OCT of the right eye.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">NSD: neurosensory retinal detachment; RPE, retinal pigment epithelium; OCT, optical coherence tomography; RE, right eye; LE, left eye.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Gargallo-Benedicto, R. Clemente-Tomás, M. Pastor-Espuig, E.G. Alías-Alegre, M.N. Navarro-Casado" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Gargallo-Benedicto" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Clemente-Tomás" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Pastor-Espuig" ] 3 => array:2 [ "nombre" => "E.G." "apellidos" => "Alías-Alegre" ] 4 => array:2 [ "nombre" => "M.N." "apellidos" => "Navarro-Casado" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669120304883" "doi" => "10.1016/j.oftal.2020.11.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120304883?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579421001602?idApp=UINPBA00004N" "url" => "/21735794/0000009700000004/v1_202205040553/S2173579421001602/v1_202205040553/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S217357942100164X" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.11.016" "estado" => "S300" "fechaPublicacion" => "2022-04-01" "aid" => "1885" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2022;97:224-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "OCT-angiography for diagnosis and response to treatment of subretinal neovascularization secondary to idiopathic macular telangiectasia type 2" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "224" "paginaFinal" => "229" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Angiografía-OCT para diagnóstico y respuesta al tratamiento de la neovascularización subretiniana secundaria a telangiectasia macular idiopática tipo 2" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1791 "Ancho" => 3333 "Tamanyo" => 637381 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Study of cases with SD OCT and OCTA 3 × 3 mm at the time of diagnosis of subretinal neovascularization (SRNV). On OCTA, SRNV can be visualized in the deep capillary plexus and avascular layer. The corresponding B-Scans show the corresponding abnormal flow in each case.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "H.E. Tapia Quijada, C. Mantolan Sarmiento, S. Gómez Perera, M. Serrano García, N. Betancor Caro, B. Haro Álvarez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "H.E." "apellidos" => "Tapia Quijada" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Mantolan Sarmiento" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Gómez Perera" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Serrano García" ] 4 => array:2 [ "nombre" => "N." "apellidos" => "Betancor Caro" ] 5 => array:2 [ "nombre" => "B." "apellidos" => "Haro Álvarez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669120304901" "doi" => "10.1016/j.oftal.2020.11.020" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120304901?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357942100164X?idApp=UINPBA00004N" "url" => "/21735794/0000009700000004/v1_202205040553/S217357942100164X/v1_202205040553/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Acute retinal pigment epitheliitis (ARPE). A case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "230" "paginaFinal" => "233" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A.B. González Escobar, A. Ibáñez García, A. Chinchurreta Capote, S. Gismero Moreno, M. Lorenzo Soto" "autores" => array:5 [ 0 => array:4 [ "nombre" => "A.B." "apellidos" => "González Escobar" "email" => array:1 [ 0 => "anadupi83@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Ibáñez García" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Chinchurreta Capote" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Gismero Moreno" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Lorenzo Soto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Costa del Sol, Málaga, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Epitelitis pigmentaria retiniana aguda (EPRA). A propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1309 "Ancho" => 1750 "Tamanyo" => 190395 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">a and b) Autofluorescence of right eye and left eye showing a hyperautofluorescent ring foveal lesion. c and d) Angiofluoresceingraphy of right eye and left eye showing a foveal lesion with central and ring hyperfluorescent mottling.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Acute retinal pigment epithelitis (ARPE) or Krill’s disease is a rare inflammatory pathology of the retina characterized by central or paracentral scotoma, blurred vision and/or uni- or bilateral metamorphopsia due to retinal pigment epithelium (RPE) dysfunction. It usually affects young, healthy individuals, resolving spontaneously within 6 to 12 weeks with good visual acuity (VA).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Described in 1972 by Krill and Deutman, it affects men and women in the same proportion.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Recurrences are unusual but have been described.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Although the etiology is unknown, sometimes there is a preceding viral disease which could trigger an immune reaction against the RPE or the neurosensory retina.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There is controversy as to whether the site of onset of the lesion is the RPE or whether it begins in the outer neurosensory retina and subsequently extends to the RPE.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Through the clinical observation of a patient with ARPE the authors wish to emphasize the contribution of optical coherence tomography (OCT), autofluorescence (AF) and angiofluoresceingraphy (AFG) in the diagnosis of this condition.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical case</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 35-year-old woman visited the emergency department with a scotoma in her left eye (LE) that had been present for 3 days. The patient had no personal history of interest and denied drug or toxic intake or other accompanying symptoms. She had a VA of 1 in her right eye (RE) and 0.05 in her LE. Intraocular pressure and biomicroscopy were normal. Fundus examination showed a yellowish subfoveal vitelliform lesion in the right eye, the right eye being normal (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The OCT of the RE was normal, and the LE showed a hyperreflective lesion from the RPE to the outer nuclear layer (ONC) with interruption of the photoreceptors (PR) associated with some thickening of the retina (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). FA of the RE was normal, and that of the LE showed a hyperautofluorescent foveal ring lesion. The FA of the RE did not show any alteration, and in the LA there was a central and ring-shaped hyperfluorescent mottling by transmission in the fovea without extravasation at late times (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). At one week she had a VA of 0.4 in the LE and the hyperreflective material had disappeared in the OCT. At one and a half months her vision improved to 0.7 and the OCT showed a slight disruption of the PR and RPE (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), with a foveal pigmentary mottling in the funduscopy. The patient was diagnosed with ARPE from the beginning due to the clinical presentation, the funduscopic and OCT findings, and the absence of other signs such as anterior uveitis or vitritis that would lead to consider another pathology.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">Although ARPE is of unknown origin,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> there are several factors that suggest it may have a viral cause: the frequency of preceding viral symptoms, the acute and transient nature, and the staggered chronology of ocular symptoms. It appears that it may be a post-viral immunological reaction, rather than an ocular manifestation of the viral infection itself.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The pathophysiology of ARPE is unknown. The RPE was thought to be the site of onset of inflammation based on clinical descriptions and electrophysiological evidence; however, OCT-based studies have shown a hyperreflective lesion in the outer neurosensory retina, suggesting that this is the site of onset of inflammation.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">On the basis of OCT findings, Hsu et al. suggested that the primary site of involvement in ARPE was the foveal PRs due to disruption of the outer-inner segment band and that the RPE-Bruch's membrane line was virtually intact. Also analyzing OCT images, Baillif et al. saw that the initial damage was at the intersection of the PR outer segments and the apical side of the RPE cells. In 2017, Iu et al. speculated that in the acute phase the outer limiting membrane (OLM) was the location of inflammation, and that the hyperreflective lesion could be an accumulation of inflammatory debris that produced the displacement of the OLM. In 2019, Yi-Hsuan Li et al. suggested that the main inflammation was located at the outer edge of the neurosensory retina. These features suggest that, contrary to previous thought, the earliest site of inflammation may be the outer retina. The involvement of OLM and ENL could be associated with damage to the PR cone nuclei, which could lead to irreversible damage. Poor visual outcome could be predicted in patients with poor VA at baseline and/or involvement of the OLM and ENL detected by OCT.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The diagnosis should be based on fundus examination, where a fine pigmentary dotting can be observed in the macular area surrounded by a hypopigmented halo, or a vitelliform lesion (these vitelliform deposits would represent the outer segments of the PRs not digested by the dysfunctional RPE, the subfoveal location of this deposit could be due to the increased metabolic activity of the PRs at that level that would make the RPE insufficiency more evident),<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> in OCT and in FA.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Hsu et al. were the first to describe EPRA findings on SD-OCT as abnormal increased reflectivity involving the CNE to the EPR with absent intraretinal, subretinal, or sub-RPE fluid.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">FA shows transmission hyperfluorescence in yellowish hypopigmented macular lesions without late diffusion.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In some cases, FA can be normal and in others it could show mild hyperautofluorescence in hypopigmented areas that may increase after the lesion disappears. RPE changes are usually permanent.</p><p id="par0060" class="elsevierStylePara elsevierViewall">OCT provided more diagnostic sensitivity for ARPE.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">A case of a patient with recurrence of ARPE has been published. It is postulated that this is due to the fact that after a viral infection the antigen provokes an immune cross-reaction towards the neurosensory retina, the RPE and the choriocapillaris, producing local inflammation. After the resolution of the first episode, when re-exposed to the antigen, a stronger immune reaction occurs and the patient presents greater VA involvement and OCT changes are more evident.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Differential diagnosis should be made with white dot syndromes, especially with multiple evanescent white dot syndrome, acute posterior multifocal posterior placoid pigment epitheliopathy and acute macular neuroretinopathy. Multiple evanescent white dot syndrome usually affects young individuals and is usually self-limited like ARPE, but the involvement is more extensive, with multiple whitish dots extending into the posterior pole and midperiphery and, on indocyanine green, shows multiple hypocyanescent lesions that outnumber the lesions visible on funduscopy and FA. Acute posterior posterior multifocal placoid pigment epitheliopathy, unlike ARPE, is usually bilateral, may be associated with neurological manifestations, vitritis may be present, and the creamy lesions are larger (1 to 2 disc diameters and located mostly in the posterior pole) corresponding to the lesions seen on indocyanine green. Common findings in ARPE are the involvement of young individuals and good visual prognosis.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Patients with acute macular neuroretinopathy present the same symptoms as in ARPE, but funduscopy shows wedge-shaped lesions pointing towards the fovea with a reddish appearance in the paracentral region whose origin could be due to ischemia in the deep retinal capillary plexus, and OCT shows hyperreflectivity in the CNE and outer plexiform as an early sign that differentiates it from ARPE and can progress to thinning of the outer nuclear.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Acute idiopathic maculopathy is included in the differential diagnosis. It affects young individuals, has a good visual prognosis and the etiology is possibly viral as the coxsackie virus has been involved. In the acute phase, funduscopy shows pigmentary changes while OCT reveals a neurosensory detachment with hyperreflective material in the subretinal space. In the convalescent phase, bull’s eye maculopathy and resolution of the neurosensory detachment on OCT with minimal changes in the RPE can be observed.</p><p id="par0080" class="elsevierStylePara elsevierViewall">A differential diagnosis must also be made with diseases in which vitelliform lesions may appear in the central macula, such as adult foveomacular dystrophy and age-related macular degeneration.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Here the presentation is usually bilateral, and the loss of VA occurs progressively. In OCT a hyperreflective lesion can be observed between the PR and the RPE.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In solar retinopathy, a foveal yellowish lesion also appears, so we should enquire about possible exposure. OCT in the acute phase shows hyperreflective areas, which are later replaced by rectangular-shaped hyporeflective cystic spaces that occupy the area of the damaged PRs.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In most publications on ARPE, patients have not received treatment due to the self-limiting nature of the disease, recovering VA within a range of 0.6 to 1 between 6 and 12 weeks.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,4,5</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–9</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Because ARPE is typically self-limiting, recognition is essential for proper counseling and to avoid unnecessary treatment. OCT in combination with clinical and AFG allows for greater diagnostic certainty.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0031">Conflict of interests</span><p id="par0021" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1700683" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1505111" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1700682" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1505110" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0011" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-07-13" "fechaAceptado" => "2020-11-21" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1505111" "palabras" => array:3 [ 0 => "Acute retinal pigment epitheliitis" 1 => "Retinal pigment epithelium" 2 => "Optical coherence tomography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1505110" "palabras" => array:3 [ 0 => "Epitelitis pigmentaria retiniana aguda" 1 => "Epitelio pigmentario retiniano" 2 => "Tomografía de coherencia óptica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A 35-year-old woman arrived in the emergency department due to loss of vision in the left eye. She had a subfoveal yellowish-looking lesion that, on optical coherence tomography (OCT), corresponded to a hyper-reflective lesion from the external nuclear layer to the retinal pigment epithelium. The lesion was reabsorbed at 6 weeks, leaving a discontinuity in the photoreceptor and retinal pigment epithelium lines. The patient was diagnosed with acute retinal pigmentary epitheliitis (ARPE).</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ARPE is a self-limiting disease with a good prognosis. Emphasis is placed on the importance of a correct diagnosis using funduscopy, OCT, and fluorescent angiography, in order to avoid unnecessary treatments.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Mujer de 35 años de edad que acudió a urgencias por pérdida de visión en ojo izquierdo. Presentaba una lesión de aspecto amarillento subfoveal que, en la tomografía de coherencia óptica (OCT), se correspondía con una lesión hiperreflectiva desde la capa nuclear externa hasta el epitelio pigmentario de la retina. La lesión se reabsorbió a las 6 semanas dejando una discontinuidad en la línea de los fotorreceptores y del epitelio pigmentario de la retina. La paciente fue diagnosticada de epitelitis pigmentaria retiniana aguda (EPRA).</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Debido a que la EPRA es una enfermedad autolimitada en el tiempo y de buen pronóstico, queremos recalcar la importancia del diagnóstico correcto mediante la funduscopia, OCT y angiofluoresceingrafía para evitar tratamientos innecesarios.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: González Escobar AB, Ibáñez García A, Chinchurreta Capote A, Gismero Moreno S, Lorenzo Soto M. Epitelitis pigmentaria retiniana aguda (EPRA). A propósito de un caso. Arch Soc Esp Oftalmol. 2022;97:230–233.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 586 "Ancho" => 1500 "Tamanyo" => 92028 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Fundus photograph showing the yellowish subfoveal vitelliform lesion in the left eye.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 425 "Ancho" => 1750 "Tamanyo" => 188532 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">a) Left eye optical coherence tomography at symptom onset showing the hyperreflective lesion from the retinal pigment epithelium to the outer nuclear with photoreceptor disruption. b) Left eye optical coherence tomography 6 weeks after symptom onset showing disruption of the photoreceptor layer and retinal pigment epithelium.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1309 "Ancho" => 1750 "Tamanyo" => 190395 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">a and b) Autofluorescence of right eye and left eye showing a hyperautofluorescent ring foveal lesion. c and d) Angiofluoresceingraphy of right eye and left eye showing a foveal lesion with central and ring hyperfluorescent mottling.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute retinal pigment epitheliitis: spectral domain optical coherence tomography, fluorescein angiography, and autofluorescence findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T. Aydoğan" 1 => "E. Güney" 2 => "B.İ Akçay" 3 => "T.K. Bozkurt" 4 => "C. Ünlü" 5 => "A. Ergin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Case Rep Med" "fecha" => "2015" "volumen" => "2015" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute retinal pigment epitheliitis: spectral-domain optical coherence tomography findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Benlahbib" 1 => "L. Meziani" 2 => "J. Akesbi" 3 => "J.P. Nordmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jfo.2015.01.004" "Revista" => array:6 [ "tituloSerie" => "J Fr Ophtalmol" "fecha" => "2015" "volumen" => "38" "paginaInicial" => "333" "paginaFinal" => "339" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25838057" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrent acute retinal pigment epitheliitis: spectral domain optical coherence tomography angiography features" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.J. Toledo" 1 => "J.R. García" 2 => "M. Asencio" 3 => "A. Schlincker" 4 => "A. López" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICB.0000000000000763" "Revista" => array:2 [ "tituloSerie" => "Retin Cases Brief Rep" "fecha" => "2018" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retinal fluorescein and indocyanine green angiography and spectral-domain optical coherence tomography findings in acute retinal pigment epitheliitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Baillif" 1 => "B. Wolff" 2 => "V. Paoli" 3 => "P. Gastaud" 4 => "M. Mauget-Faÿsse" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IAE.0b013e3181fbcea5" "Revista" => array:6 [ "tituloSerie" => "Retina" "fecha" => "2011" "volumen" => "31" "paginaInicial" => "1156" "paginaFinal" => "1163" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21293312" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Short-term clinical observation of acute retinal pigment epitheliitis using spectral-domain optical coherence tomography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.W. Kim" 1 => "S.Y. Jang" 2 => "T.K. Park" 3 => "Y.H. Ohn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3341/kjo.2011.25.3.222" "Revista" => array:6 [ "tituloSerie" => "Korean J Ophthalmol" "fecha" => "2011" "volumen" => "25" "paginaInicial" => "222" "paginaFinal" => "224" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21655052" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multicolor imaging in a case of acute retinal pigment epitheliitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Roy" 1 => "K. Saurabh" 2 => "N.R. Thomas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICB.0000000000000726" "Revista" => array:2 [ "tituloSerie" => "Retin Cases Brief Rep" "fecha" => "2018" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spectral-domain optical coherence tomography finding of acute retinal pigment epitheliitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y.H. Li" 1 => "Y.C. Chang" 2 => "W.C. Wu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/tjo.tjo_23_19" "Revista" => array:6 [ "tituloSerie" => "Taiwan J Ophthalmol" "fecha" => "2019" "volumen" => "9" "paginaInicial" => "276" "paginaFinal" => "279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31942435" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute retinal pigment epitheliitis. Diagnosis using optical coherence tomography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "O. Gutiérrez-Montero" 1 => "J.A. Reche-Sainz" 2 => "M. Rivera-Zori" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.oftal.2012.06.024" "Revista" => array:6 [ "tituloSerie" => "Arch Soc Esp Oftalmol" "fecha" => "2014" "volumen" => "89" "paginaInicial" => "58" "paginaFinal" => "61" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24269384" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term observations of patients with acute retinal pigment epitheliitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Prost" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000310022" "Revista" => array:6 [ "tituloSerie" => "Ophthalmologica" "fecha" => "1989" "volumen" => "199" "paginaInicial" => "84" "paginaFinal" => "89" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2587024" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Optical coherence tomography findings in acute retinal pigment epitheliitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Hsu" 1 => "M.S. Fineman" 2 => "R.S. Kaiser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajo.2006.07.052" "Revista" => array:6 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "2007" "volumen" => "143" "paginaInicial" => "163" "paginaFinal" => "165" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17188058" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009700000004/v1_202205040553/S2173579421001614/v1_202205040553/en/main.assets" "Apartado" => array:4 [ "identificador" => "5812" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Short communications" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009700000004/v1_202205040553/S2173579421001614/v1_202205040553/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579421001614?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
