Acute retinal pigment epitheliitis using adaptive optics imaging: a case report.

Area of Science:

• Ophthalmology
• Retinal Imaging
• Inflammatory Eye Diseases

Background:

• Acute Retinal Pigment Epitheliitis (ARPE) is a rare inflammatory retinal condition affecting young adults, often causing temporary vision loss.
• Its exact cause is debated, but it typically resolves within 6-12 weeks with vision recovery.
• Adaptive Optics Flood Illumination Ophthalmoscopy (AO-FIO) aids in detecting early cone photoreceptor damage and recovery.

Observation:

• Two patients with ARPE underwent longitudinal follow-up using multimodal imaging, including Optical Coherence Tomography (OCT) and AO-FIO.
• One patient showed bilateral vision loss, ellipsoid zone (EZ) and outer nuclear layer (ONL) disruption, and reduced cone density, with partial recovery over 15 months.
• The second patient experienced unilateral vision loss with EZ discontinuation and ONL/retinal pigment epithelium changes, showing good visual recovery but persistent reduced cone density.

Findings:

• ARPE demonstrated self-limiting disease characteristics with BCVA and OCT layer recovery within 6 months.
• Despite visual and OCT recovery, parafoveal cone density remained lower than in controls up to 15 months post-onset.
• AO-FIO revealed persistent subtle cone photoreceptor alterations not evident on OCT alone.

Implications:

• ARPE patients may experience long-term subclinical cone dysfunction despite apparent clinical recovery.
• AO-FIO offers enhanced sensitivity for monitoring retinal changes and assessing recovery in ARPE.
• This highlights the importance of advanced imaging for comprehensive evaluation of inflammatory retinal disorders.