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Acute Retinal Pigment Epithelitis. Dr. Dipankar Das, MS Dr. Rachana Jain, DO, DNB Dr.Harsha Bhattacharjee, MS Sri Sankaradeva Nethralaya, Guwahati, Assam, INDIA. Ocular History. 22 year old lady 2-2007: OD blurred vision. March 2007: First Presentation. VA: OD 20/20, OS 20/20
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Acute Retinal Pigment Epithelitis Dr. Dipankar Das, MS Dr. Rachana Jain, DO, DNB Dr.Harsha Bhattacharjee, MS Sri Sankaradeva Nethralaya, Guwahati, Assam, INDIA
Ocular History • 22 year old lady • 2-2007: OD blurred vision
March 2007: First Presentation • VA: OD 20/20, OS 20/20 • No AC, vitreous reaction • Fundus: • Resolved Multifocal choroiditis OD
March 2007: First Presentation • CBC, Chest X Ray, CT Scan Brain and orbit –Normal,VDRL-Non reactive, Mantoux test 9mm induration, FFA Resolving lesions • Kept under observation • Improvement
After 14 days March 2007 • OS Blurred vision • VA OD 20/20, OS 20/20 • No reaction in AC & vitreous • Fundus OS Creamish subretinal lesion with few hyperpigmented dark grey areas surrounded by yellowish white halo. • FFA, hypoflourescence surrounded by hyperflourescence in active lesions
After 14 days March 2007 • ERG- Normal • EOG- Subnormal Left eye • CBC, Mantoux, VDRL, CX Ray - Normal • Observation
April 2007 • VA 20/20 OD, 20/20 OS • Resolving lesion left eye
May 2007 • OD: 20/20, OS: 20/20 • Healed lesion OS
Final Diagnosis • Acute Retinal Pigment Epithelitis • Atypical clinical manifestation immitating • MEWDS • Acute Macular Neuroretinopathy • Acute posterior multifocal placoid pigment epitheliopathy • Central serous chorioretinopathy • Rubella retinitis • No treatment required
Problems • Rare • New Clinical Entity • Subtle fundus changes that can be missed, if not kept in mind.
Conclusion • Acute retinal pigment epithelitis or Krill’s disease is a rare, yet relatively new clinical entity (1972) • Characterised by Acute inflammation of the retinal pigment epithelium and manifested by transient and subtle alteration at the level of the RPE • Needs no treatment, remission and recurrences noted with good visual prognosis