Abstract
Purpose :
To describe the characteristics of sub-retinal fluid (SRF) in acquired vitelliform macular degeneration (AVMD) and highlight diagnostic challenges in this entity given the similarity to age-related macular degeneration. We examined the spectrum of image findings in patients with AVMD and provide a treatment approach in cases that are difficult to differentiate from wet age-related macular degeneration (AMD) when SRF occurs.
Methods :
A retrospective review of electronic medical record and clinical imaging of 22 eyes of 16 patients with AVMD at a single institution from 2015 - 2020. The rates of SRF, drusen, pigment epithelial detachment (PED), and patient clinical information such as age, length of follow-up, and BCVA was determined.
Results :
The mean age at diagnosis with AVMD was 72 years old with a mean follow-up time of 29 months. Median best corrected visual acuity (BCVA) was 20/29 at presentation and 20/29 at final follow-up. Drusen was a prevalent clinical feature, found in 13 of 22 eyes (59.1%) in our study. Four of 22 eyes (18.2%) had the presence of PEDs. SRF was found in 10 of 22 eyes (45.5%) at some point during their follow-up. Of these 10 eyes, in 7 eyes the SRF was located underneath the fovea (70%), recurrence occurred in 4 of 10 eyes. All recurrences of SRF were in the same location as the initial presentation of sub-retinal fluid. The average time of the occurrence of SRF in AVMD was 2.4 ± 3.6 months, and the average time of SRF disappearance was 7.6 ± 5.6 months. Three eyes received an anti-vascular endothelial growth factor injection for SRF. In 66% of cases receiving an injection the fluid later relapsed and remitted without further injections during the course of follow-up.
Conclusions :
AVMD remains a diagnostic challenge in the context of SRF, particularly when associated with drusen. In our case series, SRF tended to be central involving and recurred with or without the use of anti-VEGF injections. Proper differentiation of AVMD may prevent unnecessary long-term treatment with intravitreal anti-VEGF injections.
This is a 2021 ARVO Annual Meeting abstract.