Acquired Vitelliform Lesions in Intermediate Age-Related Macular Degeneration: A cross-sectional study

Abstract

Purpose : The study aims to define the characteristics of acquired vitelliform lesions (AVL) in patients with intermediate age-related macular degeneration (iAMD).

Methods : In this retrospective cross-sectional case-control study, we included optical coherence tomography (OCT) volume scan data from 217 eyes (168 patients) with AVL(s), and an equivalent number of control patients with iAMD without AVL (matched for age and gender). The OCT scans were evaluated for qualitative and quantitative parameters at both the eye and lesion level. Eye level parameters included the presence of: hyporeflective core drusen (hCD), intraretinal hyperreflective foci (IHRF), subretinal drusenoid deposits (SDD), pachyvessels in the macula, central retinal thickness (CRT), and central choroidal thickness (CCT). Lesion level qualitative parameters included the presence of: ellipsoid zone (EZ) and external limiting membrane (ELM) disruption overlying AVL, IHRF overlying AVL, AVL overlying drusen, pachyvessels under AVL, a solid core inside AVL, and the location of AVL. Lesion level quantitative characteristics included AVL height and width, AVL distance from the fovea, and sub-AVL choroidal thickness. Spearman's correlation analysis was performed to explore relationships among various AVL characteristics.

Results : In the comparison between the case and control groups (each with 217 eyes from 168 patients), the frequency of IHRF (case: 49.3% vs control: 26.3%) and pachyvessels in the macular region (37.3% vs 6.9%) was significantly higher in the case group, while CCT (166.1 ± 62 µm vs 206 ± 45 µm) was thinner in the case group. AVL located over drusen, with overlying IHRF, or situated subfoveally, and AVL lesions with EZ disruption, were found to have a greater lesion height and width compared to AVL lesions lacking these characteristics (P-value < 0.001 for all). Additionally, a significant negative correlation was observed between distance from the fovea and AVL height (Spearman's rho: -0.19, P = 0.002) and width (Spearman’s rho: -0.30, P=0.001).

Conclusions : This study represents the largest reported cohort of AVL lesions associated with iAMD. Novel findings include the higher frequency of pachyvessels despite a thinner choroid in these eyes, as well as a greater height and width of AVLs closer to the foveal center. These findings may offer insights into pathophysiologic mechansims underlying the development of AVLs.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.