Predictive Factors Influencing the Evolution of Acquired Vitelliform Lesions in Eyes with Intermediate Age-related Macular Degeneration

Abstract

Purpose : In this study, we aimed to identify risk factors predicting the progression of acquired vitelliform lesions (AVL) over time in eyes with intermediate age-related macular degeneration (iAMD).

Methods : This retrospective study assessed 1181 patients (2362 eyes) with AMD. After excluding cases with certain conditions and less than one year of follow-up, the final analysis included 161 patients (199 eyes) with at least one AVL lesion. The first available visit in which an AVL lesion was present was considered the baseline visit, and follow-up visit data was collected at 1,2,3, and 4 years (+/- 3 months). Progression outcomes at the following visits were classified into six categories: Resorbed (disappearance of AVL with preservation of overlying outer retina), Collapsed (disappearance of AVL with evidence of atrophy), MNV, Stable, Increasing, and Decreasing. Subsequently, we analyzed the baseline characteristics for each category and calculated odds ratios to predict these various outcomes.

Results : The collapsed group demonstrated a significantly greater baseline height and width compared to other groups (P < 0.001). Subretinal drusenoid deposits (SDD) and intra-retinal hyperreflective foci (IHRF) at the eye level, and external limiting membrane disruption and IHRF overlying the AVL were significantly more prevalent in the collapsed group (P< 0.05 for all comparisons). Odds Ratio for progressing to atrophy after 2 years of follow-up, compared to the resorbed group, were significant for SDD (OR = 3.12, P = 0.048) and AVL height (OR = 1.016, meaning each 10-micron increase in AVL height increased the odds for developing atrophy by 16 %, P = 0.006). Further regression analysis revealed that the Odds Ratio for remaining stable after 2 years of follow-up, compared to the resorbed group, was significant for the sub-foveal location of the AVL (OR = 4.26, P-value = 0.003).

Conclusions : The presence of SDD and a greater AVL height significantly increase the risk of developing atrophy in the location of AVL after 2 years of follow-up. In contrast, a sub-foveal location for the AVL significantly enhances the chance of remaining stable after 2 years. These findings may be of value in risk prognostication and defining patient populations for inclusion in future early intervention trials aimed at preventing progression to atrophy.

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