Relentless placoid chorioretinitis
Clinical Snapshot
PICO Framework
| P — Population | Young adults with relentless placoid chorioretinitis (RPC), a rare posterior uveitis |
| I — Intervention | Clinical examination, multimodal imaging including ultra-widefield imaging, and selective investigations |
| C — Comparator | Comparison with acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and serpiginous choroiditis |
| O — Outcomes | Diagnostic differentiation, clinical characteristics, and treatment considerations for RPC |
Bottom Line
Relentless placoid chorioretinitis is a rare, vision-threatening posterior uveitis affecting young adults, characterised by scattered placoid lesions at different healing stages throughout the fundus. Unlike APMPPE, RPC follows a persistent or recurrent course and typically requires immunomodulatory therapy rather than corticosteroids alone. Early recognition is crucial as the condition can cause significant visual impairment. Clinicians should utilise multimodal imaging, particularly ultra-widefield photography, to distinguish RPC from similar placoid diseases. The key diagnostic feature is the simultaneous presence of fresh creamy lesions and healing pigmented lesions, indicating the relentless nature of the disease. While resembling APMPPE more than serpiginous choroiditis, RPC's persistent course necessitates more aggressive immunosuppressive treatment to prevent ongoing retinal damage and preserve vision.
Key Findings
Effect Size: Not applicable - descriptive review
Primary Outcome: Clinical characterisation of RPC as distinct from APMPPE and serpiginous choroiditis
Nnt Or Sensitivity: Diagnostic sensitivity and specificity not quantified
Confidence Interval: Not provided
Clinical Application
Requires access to multimodal imaging including ultra-widefield fundus photography and OCT Relevant to Australian ophthalmology practice; immunomodulatory therapies mentioned are available through PBS Special Authority or private prescription Ophthalmologists and uveitis specialists managing young adults with posterior uveitis
Abstract
Relentless placoid chorioretinitis (RPC) is a rare, vision-threatening posterior uveitis that predominantly affects young adults. The hallmark clinical findings are numerous scattered placoid chorioretinal lesions involving the midperipheral and far peripheral fundus as well as the posterior pole and a persistent or recurrent course resulting in lesions at different chronological stages, with fresh creamy placoid lesions and healing pigmented lesions being present at the same time. Although RPC is frequently described as a disease that is intermediate between acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and serpiginous choroiditis, it more closely resembles APMPPE. It is important to identify those patients with RPC who present with an APMPPE phenotype so that appropriate immunomodulatory therapy is instituted without delay, as most cases of RPC are refractory to corticosteroid monotherapy. Examination findings may help differentiate RPC and APMPPE. Multimodal imaging, including ultra-widefield imaging, and selective investigations aid in distinguishing RPC from other placoid diseases and types of posterior uveitis.
References
- 1.Hooper, C. Y., Ferreira, L. B., Vaze, A., Vasconcelos-Santos, D. V., Goldstein, D. A., Gertig, D., & Smith, J. R. (2026). Relentless placoid chorioretinitis. Survey of Ophthalmology, 71(1), 1-15. https://doi.org/10.1016/j.survophthal.2025.07.009
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