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Celine Saade, Paul B Greenberg; Acquired Vitelliform Lesions in Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2061.
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© ARVO (1962-2015); The Authors (2016-present)
Acquired vitelliform lesions (AVL) represent an accumulation of yellowish subretinal material and are well described in Best’s vitelliform macular dystrophy and adult foveomacular vitelliform dystrophy. The AVLs have also been reported with age-related macular degeneration (AMD). We evaluate herein the clinically significant features of AVLs in AMD.
A PubMed search through September 2015 was conducted with the following key words: “age-related macular degeneration” and “acquired vitelliform lesions”. The inclusion criterion was articles on patients with simultaneous AVL and AMD.
Our initial search disclosed 25 articles; three met our inclusion criteria; an additional article was found through manually searching of reference lists from articles. Three studies were retrospective and one was a case report. One retrospective study involved 19 eyes from 16 patients with dry AMD and AVL (Figure) with a mean age of 79; three patients (19%) had bilateral AVLs; 13 patients were treated with anti–vascular endothelial growth factor (anti-VEGF) but therapy was discontinued after a mean of four injections due to lack of functional or anatomical benefit. The second study included 13 eyes of nine patients with a mean age of 74 years; four (44%) patients had bilateral AVLs. Using multimodal imaging, the AVLs were localized to the subretinal compartment above the RPE. The third study reviewed the clinical and imaging findings of 32 eyes of 24 patients with a mean age of 73.7 years; 8 (33%) patients had bilateral AVLs; in seven eyes treated with three consecutive monthly injections of ranibizumab, visual acuity declined by 3.6 lines. In the case report, a 72-year-old woman with AMD and an AVL in one eye was treated with three monthly injections of ranibizumab without significant impact on visual acuity or the AVL.
Most patients with AMD and AVL have lesions in one eye only. Multimodal imaging localized AVL to the subretinal compartment. Anti-VEGF therapy did not appear to be effective in AMD patients with AVL, which highlights the need to distinguish AVL from choroidal neovascularization.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Figure: Vitelliform lesion is shown as an area of combined hypo and hyper-reflectance on infrared (left) and as a well-defined dome-shaped hyporeflectivity at the level of Bruch’s membrane and hyperreflectivity of retinal pigment epithelium on spectral domain optical coherence tomography (right).
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