Classification Criteria for Acute Posterior Multifocal Placoid Pigment Epitheliopathy

PURPOSE: To determine classification criteria for acute posterior multifocal placoid pigment epitheliopathy (APMPPE).

DESIGN: Machine learning of cases with APMPPE and 8 other posterior uveitides.

METHODS: Cases of posterior uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the posterior uveitides. The resulting criteria were evaluated on the validation set.

RESULTS: One thousand sixty-eight cases of posterior uveitides, including 82 cases of APMPPE, were evaluated by machine learning. Key criteria for APMPPE included (1) choroidal lesions with a plaque-like or placoid appearance and (2) characteristic imaging on fluorescein angiography (lesions "block early and stain late diffusely"). Overall accuracy for posterior uveitides was 92.7% in the training set and 98.0% (95% confidence interval 94.3, 99.3) in the validation set. The misclassification rates for APMPPE were 5% in the training set and 0% in the validation set.

CONCLUSIONS: The criteria for APMPPE had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.