Title

ACQUIRED VITELLIFORM LESION ASSOCIATED TO VITREOMACULAR TRACTION

Introduction

Vitelliform lesions (VLs) correspond to an accumulation of yellowish hyperautofluorescent material in the subretinal space. This phenotype is shared by different retinal diseases including macular dystrophies and noninherited retinal disorders with distinct etiologies. Here we report a case of acquired foveomacular vitelliform lesion associated with vitreomacular traction and epirretinal membrane.

Methods

Case report and review of the literature.

Results

Female patient, 77 years old, with progressive vision loss, no history of surgery or intraocular inflammatory process. The vision acuity was 20/40 in the right eye and 20/50 in the left eye. The fundoscopy showed a yellowish, rounded and discreetly elevated lesion on both eyes, larger on the left. The Fluorescein Angiography showed no alterations. OCT evidenced a RPE elevation with protruding moderate reflectivity material underneath associated to epirretinal membrane in the right eye and vitreomacular traction in the left.

Discussion

The differential diagnosis between dystrophies and Acquired Vitelliform Lesion(AVL) may be difficult in patients without familial history of disease or with simultaneous macular diseases, and due to that some of them are misdiagnosed with genetic disorders. All the aforementioned retinal diseases associated with VLs share the physical separation between the photoreceptor outer segments and the retinal pigment epithelium (RPE), which could delay the phagocytosis of shed outer segment photoreceptor tips, and lead to the accumulation of subretinal material.OCT is similar to dystrophy cases but usually acquired causes are asymmetric while genetic disordes tend to be bilateral and symmetric. ERG and EOG are ordinarily normal. Regardless of the cause, the course of AVLs is generally mild. Long standing AVLs may complicate with progressive RPE atrophy after reabsorption of the accumulated material or sometimes in choroidal neovascularization, with consequent worsening of visual acuity.

Keywords

Acquired Vitelliform Lesion; Vitreomacular Traction;

Area

CLINICAL CASE

Authors

RAPHAEL SANTANA MIRALDI CLEMENTE, MARINA COSTA LACERDA, BERNARDO ANTONIO NEGREIROS MOTA, RENATA BIGOLIN SIVIERO, FELIPE MANSUR MARTIRES, GRACE KELLY PELICIONI de CASTRO, CARLOS AUGUSTO MOREIRA NETO, CARLOS AUGUSTO MOREIRA JUNIOR