ABSTRACT
Purpose : Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a generally self-limited disease with a good prognosis and resolution of symptoms between 4 weeks and 6 months. Retinal imaging is used to establish the diagnosis;however, the resolution of routine diagnostic imaging to assess changes at the photoreceptor level is limited. Here we explored outer cellular retinal structure of APMPPE lesions in a patient 4 years after initial presentation and 8 months after recurrent scotoma symptoms in the same region as her initial APMPPE scotomas a few days after her first COVID-19 vaccine. Methods : The subject underwent a complete eye exam and high resolution imaging. Outer retinal structure was assessed using spectral domain optical coherence tomography (SD-OCT), and the photoreceptor mosaic was imaged using both confocal and split detection adaptive optics scanning light ophthalmoscopy (AOSLO). Results : SD-OCT identified a subtly irregular ellipsoid zone (EZ) band in the area of a previous APMPPE lesion, improved from initial presentation and initial visit after reactivation. Confocal AOSLO (Figure A) revealed an abrupt transition from dense regularly spaced cones to a disrupted photoreceptor mosaic. However, confocal AOSLO signal can be difficult to interpret in the presence of debris or non-waveguiding cones. Split detection AOSLO (Figure B) highlights cone inner segments providing a clearer view of cone distribution even in the absence of waveguiding and revealed reduced photoreceptor density in disrupted areas (Figure A and B '∗'). Conclusions : COVID-19 vaccination may induce reactivation of APMPPE symptoms. Despite improved EZ band structure by SD-OCT in the areas of previous APMPPE lesions, AOSLO revealed several focal areas of persistent subclinical photoreceptor loss. Split detection AOSLO allows for more precise assessment of photoreceptor structure and highlights the variability in inner segment changes throughout retina lesions. This demonstrates the potential utility of split-detector AOSLO for assessment of photoreceptor structure alterations in retinal uveitic diseases such as APMPPE. (Figure Presented).