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Sabah Shah, Vinnie Shah, K Bailey Freund; Vitelliform-Like Lesions Associated with Type 1 Choroidal Neovascularization. Invest. Ophthalmol. Vis. Sci. 2013;54(15):6294.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the multimodal imaging findings of a vitelliform-like lesion (VLL) observed over type 1 (sub-RPE) choroidal neovascularization (CNV) in patients with neovascular age-related macular degeneration (AMD).
A retrospective review of 11 eyes of 11 patients with VLLs associated with type 1 CNV due to AMD. Patients were examined using multimodal imaging including spectral domain optical coherence tomography (OCT), fluorescein angiography (FA), fundus autofluorescence (FAF) imaging, and fundus photography. Baseline characteristics were noted and changes in visual acuity and imaging findings were evaluated following the initiation of intravitreal anti-VEGF therapy.
Eleven eyes of 11 patients (10 female, 1 male) with VLLs associated with type 1 CNV were studied. Mean age at first detection of the VLLs was 71.2±10.8 years. The mean follow-up following VLL detection was 1.8±0.6 years. FA in all 11 eyes showed leakage and/or staining of underlying type 1 CNV, but not of the VLL itself, differentiating this material from type 2 (subretinal) neovascular tissue. In 6 eyes, the VLLs showed hypoautoflourescence and in 5 eyes the VLLs showed varying degrees of hyperautoflourescence. With OCT, all 11 eyes had evidence of hyper-reflective material in the subretinal space overlying type 1 CNV. Five eyes had an associated serous pigment epithelial detachment, 6 eyes had evidence of subretinal fluid, 2 eyes had subretinal hemorrhage, 2 eyes had subretinal fibrosis, and 1 eye had subfoveal RPE atrophy. Unlike eyes with typical vitelliform lesions, all 11 eyes with VLLs showed resolution of the subretinal material with reconstitution of the IS/OS junction following a mean of 12 injections. Mean visual acuity prior treatment was 20/85 and improved to 20/75 at the most recent follow-up.
Unlike most acquired vitelliform lesions occurring in the absence of CNV, VLLs associated with type 1 CNV show a favorable anatomic response to intravitreal anti-VEGF therapy with visual improvement in some eyes. VLLs appear to represent a form of exudation distinct from subretinal fluid, hemorrhage, and the material seen in Best macular dystrophy and acquired vitelliform lesions.
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