Multimodal imaging of adult vitelliform maculopathy and possible predictors of visual acuity

Session Details

Session Title: Free Paper Session 17: Imaging II

Session Date/Time: Saturday 09/09/2017 | 08:00-09:30

Paper Time: 08:42

Venue: Room 120

First Author: : S.Parreira PORTUGAL

Co Author(s): :    S. Parreira   D. Lopes   M. Pereira   N. Campos                    

Abstract Details

Purpose:

Adult Vitelliform Maculopathy (AVM) arises between 30-50 years old, with variable genetic inheritance (tipically autossomal dominant). Bilateral, symmetrical, yellowish, round elevated lesions ranging from 1/3 to 1 DD are hallmarks. OCT reveals lesions located in the RPE or between the RPE and the photoreceptor layer. They typically exhibit hiperautofluorescence. Two combined can provide complete understanding of the natural history of the disease and be used in the evaluation and follow-up of patients. We describe a series AVM patients with imaging documentation of all different stages of the disease. Correlations between morphological and functional parameters were attempted. Literature was reviewed.

Setting:

Department of Ophthalmology, Hospital Garcia de Orta.

Methods:

Retrospective case series of 11 eyes of 6 patients with AVM. Complete ophthalmological evaluation, retinography, SD-OCT imaging and autofluorescence images were obtained. Intensity of lesions’ autofluorescence was obtained using Matlab (The Mathworks Inc, Natick, MA, USA). Literature was reviewed through Pubmed data base for a combination of terms: adult vitelliform maculopathy, OCT, fundus autofluorescence, imaging.

Results:

Eleven eyes with AVM were evaluated through corrected visual acuity, fundoscopy, OCT and autofluorescence. Macular lesions were bilateral in 5 out of 6 patients. The mean MAVC was 0.46 on the Snellen scale [0.25-0.8]. At fundoscopy the most prevalent lesions were egg-yolk (n=3) and pigmentary alterations with macular hypopigmentation (n=4). The most prevalent morphology observed on SD-OCT was a homogeneous hyperreflective (n=5). The most prevalent autofluorescence pattern was central hyperautofluorescence (n=6). Disease progression through different stages similar to those present in Best dystrophy were found and well documented in this case series. The mean lesion thickness was 150um [5-50um] and the mean neurosensory retinal thickness above lesion was 150um [100-190um]. Positive correlations were found close to the statistical significance between visual acuity and neurosensory retinal thickness above the lesion and negative correlation between lesion thickness and ellipsoid zone integrity. No correlation was found with autofluorescence pattern.

Conclusions:

Adult viteliform lesions typically have a benign course, with slow evolution over time. However, loss of visual acuity may occur and be related to the development of choroidal neovascular membrane or chorioretinal atrophy. Submacular deposits that accumulate in retinal pigmented epithelium (RPE) or between RPE and neurosensory retina can be detected by OCT and have autofluorescence matching. There are very few studies correlating morphology and function in AVM through different imaging modalities and this was the first attempting correlations with autofluorescen. Although results with statistical significance were not obtained, this is probably due to sample size. Additional studies would provide further information. The size of the deposits, the thickness of the neurosensory retina above these and the integrity of ellipsoid zone may correlate with final visual outcome.

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