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Placoid lesions of the retina: progress in multimodal imaging and clinical perspective
  1. Alessandro Marchese1,
  2. Aniruddha Kishandutt Agarwal2,
  3. Stefano Erba3,
  4. Antonio Scialdone3,
  5. Elisabetta Miserocchi1,
  6. Francesco Bandello1,
  7. Ugo Introini1,
  8. Lee M Jampol4,
  9. Giuseppe Casalino3
  1. 1 Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
  2. 2 Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
  3. 3 Oftalmico Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
  4. 4 Department of Ophthalmology, Northwestern University, Chicago, Illinois, USA
  1. Correspondence to Dr Giuseppe Casalino, Oftalmico Hospital, Piazza Principessa Clotilde n.3, 20121, Milan, Italy; peppecasalino{at}


Placoid lesions of the retina may be secondary to a wide spectrum of acquired inflammatory conditions that have been reported as single entities with different presentation and clinical course. These conditions include acute posterior multifocal placoid pigment epitheliopathy, persistent placoid maculopathy, serpiginous choroiditis, serpiginous-like choroiditis, relentless placoid chorioretinitis and acute syphilitic posterior placoid chorioretinitis. In this article, we will group these conditions under the name of ‘placoids’. The recognition of the specific condition may be challenging in clinical practice, often resulting in diagnostic and therapeutic delay. Given the complex nature of placoids and their similarities, a systematic approach including differentiating between infectious and non-infectious aetiologies increases the chance of reaching the correct diagnosis. Detailed history and comprehensive clinical examination are the first steps to formulate a diagnostic hypothesis that should be corroborated by multimodal imaging and appropriate investigations. The advent of multimodal imaging has made it possible to extensively study placoids and revealed a constellation of specific findings that may help clinicians in the diagnostic process. The treatment of the conditions other than syphilis is complex and sometimes challenging. Our article is aimed at giving an overview of the individual entities associated with placoids and discussing the differential diagnosis. A practical and systematic approach is then proposed.

  • inflammation
  • retina
  • choroid
  • imaging

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  • Contributors Conceptualisation and supervision: GC, LMJ. Data curation/literature review: AM, AKA, SE, AS, EM, UI and FB. Tables and figures preparation: AM, SE. Writing draft, review and editing: AM, AKA, LMJ, GC. Overall coordination: GC. All authors approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.