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November 2009


Inside Inflammation

Rare condition damages eye tissues

Normal on left, abnormal on right. APMPPE

These color photographs were taken through the pupil. They show the back of the right eye, known as the retina. The retina on the left is healthy. The retinal image on the right is from a person who has a rare condition called acute posterior multifocal placoid pigment epitheliopathy, or APMPPE.

The cause of this inflammatory eye disease is unknown, but it typically affects young adults. Some patients experience flu-like symptoms before they have eye symptoms. In the eye, the condition involves damage to the retina and two other eye tissues: the retinal pigment epithelium (RPE) just below the retina, and the choroid just below the RPE.

RPE tissue plays a vital role in the vision process. It nourishes the light-sensitive photoreceptor cells and recycles visual pigment molecules, which detect light that strikes the retina. The choroid contains blood vessels that provide oxygen and other nourishment to the retina.

The white-yellow areas in these images indicate that the retina is damaged. In the center of the retina, known as the macula, the retina and RPE tissue is damaged so much that the blood vessels in the choroid can be seen. The dark black areas show clumps of RPE tissue, most likely from inflammation in the cells.

Inflammation or breakdown of the RPE tissue occurs in inflammatory eye conditions, including APMPPE. These changes can cause severe vision loss. Some people who have APMPPE may experience improvement with treatments that decrease inflammation, such as corticosteroid medications, or with medications that suppress the immune system.

Images courtesy of NEI staff clinician H. Nida Sen, M.D., M.H.Sc., clinical fellow Lisa J. Faia, M.D., ophthalmic imaging specialist Michael Bono, B.A., C.R.A., C.O.T., and chief of the NEI Imaging Services Section Denise Cunningham, C.R.A., M.Ed.

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Department of Health and Human Services NIH, the National Institutes of Health