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K. Freund, L. H. Lima, K. Laud, S. A. Zweifel, R. F. Spaide, L. A. Yannuzzi; Adult-Onset Vitelliform Detachment: Correlation of Clinical Findings and Multiple Imaging Analyses. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1635.
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To correlate clinical observations with multi-modal imaging analysis in adult-onset vitelliform detachment (AVD) and to elucidate its nature, pathogenesis and natural course.
Clinical examination, color fundus photography, fluorescein angiography (FA), near-infrared (nIR) reflectance, fundus autofluorescence (FAF) and spectral domain optical coherence tomography (SD-OCT) data were retrospectively reviewed for a consecutive series of 102 eyes of 68 patients with AVD secondary to a variety of diagnoses.
In all 102 eyes with AVD, SD-OCT helped localize the clinically apparent yellowish material with respect to the retinal layers. Only 22 of 102 (21.6%) eyes had SD-OCT evidence of subretinal fluid (SRF). All eyes exhibited abnormal hyper-autofluorescence corresponding to material seen clinically. Twenty-one (20.1%) eyes exhibited nIR hyper-reflectivity corresponding to presumed collections of pigment-laden macrophages and retinal pigment epithelium (RPE) cells. Resolution of some AVDs appeared to coincide with progressive thinning of the outer nuclear layer (ONL) indicating progressive loss of photoreceptors. Visual acuity was best predicted by integrity of the ELM (p=0.002) on SD-OCT. Fluorescein angiography revealed a pattern often mimicking poorly defined (type 1) choroidal neovascularization.
Adult vitelliform detachment occurs in a variety of different clinical entities that show common findings with multi-modal 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 AVD. Ongoing photoreceptor loss may in some cases be associated with the spontaneous resolution of an AVD.
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