Placoid pigment epitheliopathy with retinal vasculitis and papillitis.

Attention was drawn by Gass (i968) to a distinctive fundus appearance of numerous, widespread, flat, yellowish-white lesions at the level of the retinal pigment epithelium and choroid, associated with rapid loss of visual function.Gass proposed the descriptive name "acute posterior multifocal placoid pigment epitheliopathy" for this condition and noted the spontaneous resolution of the lesions which occurred after several months with improvement in the visual acuity.This report concerns two patients in whom the clinical and fluorescein angiographic findings conform to the description given by Gass (I968) but in whom retinal vasculitis and, in one case, papillitis, were additional features. Case reportsCase I, a 26-year-old male carpenter, was admitted to the National Hospital (A6o882) under the care of Dr. C. J. Earl, complaining of bilateral visual impairment.He had developed an "inflammation" of the right lower eyelid 2 months before admission; this had resolved spontaneously after i week and shortly after this episode he noticed blurring of the vision in the right eye.He was seen at his local hospital and the visual acuity was found to be i/6o in the right eye and 6/6 in the left.Bilateral optic disc swelling was detected and the appearances were interpreted as those of an atypical retrobulbar neuritis.Treatment was commenced with 8o units of ACTH daily.He began to experience intermittent flashes of light in both eyes lasting for 2 or 3 seconds at a time which continued irregularly throughout the day, and 2 weeks after the onset of this symptom the visual acuity in the left eye deteriorated to 6/I8.There was no relevant past medical or family history. ExaminationVisual acuity in the right eye was counting fingers, N48, with absent colour vision (Ishihara), and in the left eye 6/i8, N5, with normal colour vision.Perimetry showed bilateral central scotomata with a ring scotoma present in the right eye and a broad superior arcuate defect in the left eye (Fig. i, overleaf).The right pupil showed a relative afferent defect.The ocular movements were normal.Slit-lamp examination showed the anterior chamber and vitreous to be clear.The intraocular pressures were normal.Fundus examination showed multiple, discrete, flat, yellow lesions, some of which were irregularly pigmented and distributed in the postequatorial area.The placoid lesions involved the macula in the right eye but the left macula appeared normal.The optic discs were slightly swollen.The