Acute posterior multifocal placoid pigment epitheliopathy following COVID-19 infection

Abstract

Purpose: To report a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) following COVID-19 infection. Observations: A 17-year-old female developed central scotomas and photopsias two weeks after SARS-CoV-2 diagnosis with polymerase chain reaction studies. She presented with poor visual acuity of 3/60 on the Feinbloom eye chart in the left eye. Dilated examination and multi-modal retinal imaging were consistent with the diagnosis of APMPPE, with noteworthy subretinal fluid. The patient was treated with an oral prednisone taper starting at 60mg with rapid resolution in subretinal fluid and improvement of visual acuity. Five weeks after presentation, visual acuity improved to 20/20 OU with complete resolution of the creamy white choroidal lesions and subretinal fluid. Conclusion: There is a growing body of literature reporting the ocular manifestations of COVID-19. Rarely inflammation of the retina or choroid have been associated with the infection. To the best of our knowledge, there are no prior reports that describe the clinical course or visual outcome in a patient with APMPEE associated with recent COVID-19 infection. Accordingly, we are not aware of any other reports that describe the treatment of APMPEE associated with COVID-19 with corticosteroids. The mechanism linking COVID-19 infection to inflammatory ocular disorders in unclear and likely multi-factorial.

Keywords

• Acute posterior multifocal placoid pigment epitheliopathy
• Coronavirus disease 2019
• COVID-19
• Multi-modal retinal imaging