Multifocal Posterior Pigment Epitheliopathy Complicated by Circumferential Choroidal Detachment Treated With Fluorescein Angiography-Guided Focal Laser Photocoagulation: A Case Report

Multifocal posterior pigment epitheliopathy (MPPE) is a pachychoroid-related disorder characterized by choroidal hyperpermeability and serous retinal detachment (SRD), typically without choroidal detachment (CD). We report a rare case of MPPE complicated by circumferential CD in a man in his late 50s with chronic myeloid leukemia in molecular remission. Fundus examination revealed multiple yellowish-white exudative lesions with SRD at the posterior pole and peripheral CD. Fluorescein angiography (FA) demonstrated multiple focal leakage points with progressive dye leakage, while indocyanine green angiography showed early hypofluorescence followed by late hyperfluorescence. Although the presence of CD suggested possible overlap with uveal effusion, the overall clinical and angiographic findings were predominantly consistent with MPPE. Focal laser photocoagulation was applied to angiographically identified leakage sites; however, repeat angiography revealed newly developed leakage points requiring additional treatment. Both SRD and CD gradually resolved, with complete resolution five months after therapy. This case suggests that localized MPPE-related leakage may have played a predominant role in the development of circumferential CD and highlights the importance of repeated angiographic evaluation and FA-guided treatment in complex or atypical presentations of pachychoroid-related disorders.