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Elisha Garg, Juliet Essilfie, Riccardo Sacconi, Giuseppe Querques, David Sarraf; Acquired Vitelliform Maculopathy in Pachychoroid Pigment Epitheliopathy and Comparison to Acquired Vitelliform Maculopathy in Reticular Drusen. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3150. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the association between acquired vitelliform lesions (AVL) and pachychoroid pigment epitheliopathy (PPE), and to compare the demographic, clinical manifestations, and anatomical OCT findings between this entity and acquired vitelliform maculopathy seen in reticular drusen.
Eyes in patients age greater than fifty years old with AVLs and PPE or RD, with sufficient view for measurement on OCT imaging were included for review. Vitelliform lesions from other known causes or where the diagnosis of PPE or RD was uncertain were excluded. 12 patients and 19 eyes were included in the AVL-PPE arm. 6 patients and 9 eyes were included in the AVL-RD arm. Patient baseline characteristics, visual acuity, and multi-modal imaging through EDI OCT, OCT angiography, fundus photos, and fundus autofluorescence were obtained. Lesion foveal cross sectional area and OCT choroidal thicknesses at the fovea, 1500 um nasal, and 1500 um temporal to the fovea were measured.
No difference was found between patient age and demographic between the two groups. Mean age of AVL-PPE group was 68.75 years. Mean age of AVL-RD group was 77.5 years (p=0.1360). Mean LogMAR visual acuities were 0.26 and 0.25 (p=0.9452), corresponding to a Snellen visual acuity of approximately 20/36 for both groups. However, differences in choroidal thicknesses were statistically significant. In the AVL-PPE group, average subfoveal, 1500 μm nasal, and 1500 μm temporal choroidal thicknesses were 322.79 μm, 302.37μm, and 281.95 μm, while average choroidal thickness measurements in the AVL-RD group were 229.00 μm subfoveal, 188.89 μm 1500 μm nasal, and 225.11 μm 1500 μm temporal (p=0.0021, p=0.0002, p=0.0318). There were no differences between the foveal cross sectional size of the lesions, measuring 0.17 mm2 and 0.21 mm2 between the AVL-PSD and the AVL-RPD groups (p=0.6792).
The association between AVL with RD is known, but the association of AVL with PPE has not yet been described. Accumulation of lipofuscin-like material from undigested photoreceptor outersegments due to RPE dysfunction is well supported in the literature and this study. This study suggests the pathogenesis of RPE dysfunction may be secondary not only to thin, but also thick choroid in PPE. The exact mechanism underlying choroid mediated RPE dysfunction still remains to be elucidated.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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