an 18-year - old man was referred to our clinic for the evaluation of blurred vision involving the left eye that had manifested four days previous . he had no specific medical , ocular , or trauma history .
the subject 's best - corrected visual acuity was 1.0 in the right eye and 0.9 in the left eye .
vf ( central 10 - 2 sita - standard strategy ) was measured with a humphrey field analyzer ii ( zeiss - humphrey , san leandro , ca , usa ) under continuous monitoring .
the oct demonstrated disruption in the photoreceptor inner and outer segment ( is / os ) junction and undulation of the rpe with backscattering ( fig .
2c ) , but the oct findings did not reveal improvement compared to the initial findings ( fig .
the oct demonstrated a recovery of continuity in the photoreceptor is / os junction , as well as decreased rpe irregularity with minimal backscattering ( fig .
arpe is an acute , transient , foveal disturbance of unknown cause and which affects young adults .
because of scarce case reports and an infrequent prevalence of the disease , the diagnosis can be difficult without suspicion .
fluorescein angiography ( fa ) is a critical test for the differential diagnosis of arpe .
unfortunately , we could not obtain fa data because t he patient had signs of an anaphylactic reaction , such as dizziness and difficulty breathing , immediately after the fluorescein injection .
therefore , we made a diagnosis based on the fundus findings in combination with the oct and other characteristics of the disease .
white dot syndromes , especially multiple evanescent white dot syndromes ( mewds ) , should be considered in the differential diagnosis of arpe .
white dot syndromes are characterized by multifocal white lesions and are accompanied by mild vitritis .
mewds differs from arpe in that the lesions are located outside the macula in the posterior pole , and electroretinogram ( erg ) findings are abnormal .
the main lesions responsible for mewds cause damage to the photoreceptor outer segment but not the rpe . in our case
, there was a single white dot lesion that was limited to the juxtafoveal region ; also , erg , which was performed on the first visit , showed normal findings . in acute posterior multifocal placoid pigment epitheliopathy ( apmppe ) ,
multiple , large placoid lesions start in the posterior pole and extend to the post - equatorial fundus , often accompanied by prodromal flu - like symptoms . our patient 's lesions were discrete clusters of a few subtle , small grey spots that resolved without scarring within three months after onset .
in contrast , the lesions in patients with apmppe are replaced by rpe changes upon resolution .
the oct demonstrated rpe involvement , which was similar to the previously reported oct findings .
based on these findings , other diseases were ruled out and the patient was diagnosed with arpe .
hsu et al .   first described the oct findings of patients with arpe using time domain oct ( oct3 ; carl zeiss ) as a hyper - reflectivity involving the outer nuclear layer , photoreceptor , and rpe .
hyper - reflectivity has not yet been evaluated with sd - oct . in our case
, we found a definite disruption in the is / os junction , as well as an undulation of the rpe according to sd - oct .
because sd - oct can provide better image resolution than oct3 , we believe that the disruption of the is / os junction with sd - oct presented as a hyper - reflectivity of the outer retina with oct3 . as reported by hsu et al . , the thickness of the hyper - reflectivity decreased with increased resolution , and we found a decreased length of the is / os disruption based on the serial observations of the oct findings .
the rpe irregularity also decreased as the symptoms improved and as the threshold of the visual field increased . on the basis of these findings
, the morphologic changes in inflammation related to arpe do not seem to be permanent .
 we investigated the case of a young man with blurred vision in his left eye . 
 his visual acuity was slightly decreased , and ophthalmoscopy disclosed a gray - white lesion in the macula . 
 he had no systemic or ocular history . 
 on the visual field test , the threshold sensitivity was decreased in the corresponding region . 
 spectral domain optical coherence tomography ( oct ) demonstrated a disruption in the photoreceptor inner and outer segment ( is / os ) junction and undulation of the retinal pigment epithelium ( rpe ) with backscattering . 
 we re - examined the patient after two weeks and after three months without any treatment . visual acuity and visual field results were gradually normalized , and oct demonstrated the recovery of continuity in the photoreceptor is / os junction , as well as decreased rpe irregularity with minimal backscattering . 
 we used spectral domain oct instead of time domain oct ( oct3 ) so that we could provide better image resolution of the acute retinal pigment epitheliitis ( arpe ) . 
 finally , we observed recovery of the functional and anatomical changes in the arpe patient with a resolution of the condition within three months following the initial examination , using oct and visual field tests . 