Acute posterior multifocal placoid pigment epitheliopathy and Harada's disease

Two healthy Japanese patients developed bilateral pigment epitheliopathy. No inflammatory sign was observed at the time of onset. Multiple yellowish-white placoid lesions developed in the macular region after which vision was seriously disturbed. Fluorescein angiography showed hypofluorescence at the early stage and hyperfluorescence at the later stage--a finding coincident with the placoid lesions. In Case 1 a similar attack in the right eye occurred half a year later, and of the left eye seven years later. New placoid lesions were observed at sites of previous lesions and also at new sites. Lesions of both fundi resolved, rapidly leaving pigment clumps, and visual prognosis was good. The clinical experience of Case 1 were quite similar to acute posterior multifocal placoid pigment epitheliopathy (APMPPE). In Case 2 the placoid lesions spontaneously resolved within a month. However, fluorescein angiography showed multiple pinpoint leaks occurring at the level of the pigment epithelium, and at the resolved stage a "sunset glow" fundal appearance was observed. The second attack was observed four months after the first onset, with iridocyclitis accompanying it. These clinical features were similar to Harada's disease while some were similar to APMPPE.