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ACQUIRED VITELLIFORM LESIONS: Correlation of Clinical Findings and Multiple Imaging Analyses

Freund, K Bailey MD*†‡; Laud, Ketan MD*†‡; Lima, Luiz H MD; Spaide, Richard F MD*†; Zweifel, Sandrine MD†§; Yannuzzi, Lawrence A MD*†

doi: 10.1097/IAE.0b013e3181ea48ba
Original Study

Purpose: To correlate clinical observations with multimodal imaging analysis in acquired vitelliform lesions (AVLs) and to elucidate their nature, pathogenesis, and natural course.

Methods: Clinical examination, color fundus photography, fluorescein angiography, near-infrared reflectance, fundus autofluorescence, and spectral-domain optical coherence tomography (SD-OCT) data were retrospectively reviewed for a consecutive series of 90 eyes of 67 patients with an AVL secondary to a variety of diagnoses.

Results: In all 90 eyes with AVLs, SD-OCT helped localize the clinically apparent yellowish material to the subretinal space above the retinal pigment epithelial (RPE) band. Only 19 eyes (21.1%) had SD-OCT evidence of subretinal fluid. All eyes exhibited abnormal hyperautofluorescence corresponding to the material seen clinically. In 18 of 72 eyes (25.0%) imaged simultaneously with SD-OCT and near-infrared reflectance imaging, near-infrared hyperreflectivity corresponding to presumed collections of pigment-laden macrophages and RPE cells was observed. Resolution of some AVLs appeared to coincide with progressive thinning of the outer nuclear layer, indicating a gradual loss of photoreceptors. Visual acuity at baseline was best predicted by the subfoveal integrity of the external limiting membrane (P = 0.001) and the inner segment/outer segment junction (P = 0.0002) on SD-OCT. Fluorescein angiography revealed a pattern often mimicking poorly defined (Type 1) choroidal neovascularization.

Conclusion: Acquired vitelliform lesions occur in a variety of different clinical entities that share common features with multimodal imaging analyses. We propose that both dysfunctional RPE and loss of apposition between the photoreceptor tips and the RPE can interfere with the phagocytosis of shed outer segments. Both this material and pigment-laden macrophages and RPE cells appear to contribute to the yellowish appearance of AVLs. Ongoing photoreceptor loss may in some cases be associated with the spontaneous resolution of an AVL.

Acquired vitelliform lesions occur in a variety of different clinical entities that share common features with multimodal imaging analyses. The authors propose that both dysfunctional RPE and loss of apposition between the photoreceptor tips and the RPE can interfere with the phagocytosis of shed outer segments. Both this material and pigment-laden macrophages and RPE cells appear to contribute to the yellowish appearance of AVLs. Ongoing photoreceptor loss may in some cases be associated with the spontaneous resolution of an AVL.

From the *Vitreous-Retina-Macula Consultants of New York, New York, New York; †LuEsther T. Mertz Retinal Research Center, New York, New York; ‡Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York; and §Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland.

Supported by the LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, and The Macula Foundation, Inc.

Reprint requests: K. Bailey Freund, MD, Vitreous-Retina-Macula Consultants of New York, 460 Park Avenue, 5th Floor, New York, NY 10022; e-mail: kbfnyf@aol.com

© The Ophthalmic Communications Society, Inc.