Acute retinal pigment epitheliitis: spectral-domain optical coherence tomography findings in 18 cases

To describe the imaging characteristics and to investigate the prognostic factors of acute retinal pigment epitheliitis.

In this retrospective observational case series, a total of 18 patients (18 eyes) with acute retinal pigment epitheliitis were included. The features of acute retinal pigment epitheliitis were analyzed by spectral-domain optical coherence tomography (SD-OCT).

Spectral domain-OCT images obtained at baseline revealed abnormal reflectivity in the RPE inner layer in every case (18 eyes, 100%). The line corresponding to the RPE inner layer, the inner segment ellipsoid (ISe), showed abnormal reflectivity in 16 cases (89%). Among patients with ISe abnormalities, three eyes (17%) also showed external limiting membrane (ELM) disruption and two expanded abnormal reflectivity in the outer nuclear layer (ONL). With time, SD-OCT images showed disappearance and gradual resolution of the ONL hyperreflectivity, and disruption of the ELM or ISe. Sixteen eyes (89%) fully recovered their BCVA within 2 months. However, two eyes (11%) with involvement of the ELM or ONL at baseline, with BCVA of less than 20/70 at baseline, showed incomplete BCVA recovery after more than 1 year of follow-up.

Spectral domain-OCT findings indicated that the initial lesion in acute retinal pigment epitheliitis is located at the junction between the photoreceptor outer segments and the apical sides of the RPE cells. Poor visual acuity at baseline and involvement of the ELM or ONL on SD-OCT at baseline were associated with the incomplete recovery of visual acuity.