Natural course of adult-onset vitelliform lesions in eyes with and without comorbid subretinal drusenoid deposits

Yeung, Aaron Ming-Hon; Wilde, Craig; Awad, Mary; Giannouladis, Konstantinos; Lakshmanan, Arun; Dua, Harminder; Amoaku, Winfried M.K.

Abstract

Purpose

Adult vitelliform lesions (AVL) are associated with age related macular degeneration (AMD) and subretinal drusenoid deposits (SRDD). We evaluated the natural course of AVL, assessing the influence of SRDD on disease progression, visual function and incidence of macular atrophy (MA) and choroidal neovascular membranes (CNVM).
Methods

A retrospective cohort study was conducted between January 2011 and March 2016. Demographic, clinical and imaging data from 26 consecutive AVL patients were analysed following case note review. Optical coherence tomography images were graded for SRDD and patients divided into those with/without SRDD. Outcomes included presenting/changes in best corrected visual acuity (BCVA) and incidence of MA/CNVM.
Results

Mean age was 78.6 ± 7.6 years. Mean follow-up was 51.5 ± 25.6 months. Twelve patients (46.2%) had SRDD at presentation with 3 more (11.5%) developing them. Subjects with SRDD were older (mean 81.7 ± 6.1 years vs 74.3 ± 7.6 years, p = 0.010). Mean presenting BCVA was worse in SRDD eyes (0.39 ± 0.31 logMAR vs 0.19 ± 0.18 logMAR, p = 0.017). Eight of 15 patients with SRDD (53.3%) developed incident MA or CNVM; higher than those with no SRDD (1/11, 9.1%; p = 0.036). Two patients (7.7%) developed full thickness macular holes.
Conclusions

Patients with AVL and SRDD likely represent an advanced pathological stage or phenotype with worse visual outcome and higher risk of MA/CNVM. Possible overlap with AMD exists. Follow-up, counselling and provisions for early detection/treatment of complications should be made. Better classification including improved understanding of phenotypic and genetic variations with reference to comorbid diseases including AMD is required. Presence of SRDD in AVL offers a dichotomous classification, indicating risk of future MA/CNVM formation.

Citation

Yeung, A. M.-H., Wilde, C., Awad, M., Giannouladis, K., Lakshmanan, A., Dua, H., & Amoaku, W. M. (2020). Natural course of adult-onset vitelliform lesions in eyes with and without comorbid subretinal drusenoid deposits. International Ophthalmology, 40, 1501–1508. https://doi.org/10.1007/s10792-020-01319-2

• Journal Article Type: Article
• Acceptance Date: Feb 10, 2020
• Online Publication Date: Mar 4, 2020
• Publication Date: 2020-06
• Deposit Date: Mar 6, 2020
• Publicly Available Date: Mar 6, 2020
• Journal: International Ophthalmology
• Print ISSN: 0165-5701
• Electronic ISSN: 1573-2630
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 40
• Pages: 1501–1508
• DOI: https://doi.org/10.1007/s10792-020-01319-2
• Keywords: Ophthalmology
• Public URL: https://nottingham-repository.worktribe.com/output/4096652
• Publisher URL: https://link.springer.com/article/10.1007%2Fs10792-020-01319-2
• Additional Information: Received: 17 October 2019; Accepted: 10 February 2020; First Online: 4 March 2020; : ; : No conflicting relationship exists for any author regarding this manuscript.; : Ethics committee approval was not required for this study, and it adhered to ethical principles outlined in the declaration of Helsinki.