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Iovino C, Ramtohul P, Au A, Romero-Morales V, Sadda S, Freund KB, Sarraf D. Vitelliform maculopathy: Diverse etiologies originating from one common pathway. Surv Ophthalmol 2023; 68:361-379. [PMID: 36720370 DOI: 10.1016/j.survophthal.2023.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/31/2023]
Abstract
Vitelliform lesions (VLs) are associated with a wide array of macular disorders but are the result of one common pathway: retinal pigment epithelium (RPE) impairment and phagocytic dysfunction. VLs are defined by the accumulation of yellowish subretinal material. In the era of multimodal advanced retinal imaging, VLs can be further characterized by subretinal hyperreflectivity with optical coherence tomography and hyperautofluorescence with fundus autofluorescence. VLs can be the result of genetic or acquired retinal diseases. In younger patients, VLs usually occur in the setting of Best disease. Additional genetic causes of VL include pattern dystrophy or adult-onset vitelliform macular dystrophy. In older patients, acquired VLs can be associated with a broad spectrum of etiologies, including tractional, paraneoplastic, toxic, and degenerative disorders. The main cause of visual morbidity in eyes with VLs is the onset of macular atrophy and macular neovascularization. Histopathological studies have provided new insights into the location, nature, and lifecycle of the vitelliform material comprised of melanosomes, lipofuscin, melanolipofuscin, and outer segment debris located between the RPE and photoreceptor layer. Impaired phagocytosis by the RPE cells is the unifying pathway leading to VL development. We discuss and summarize the nature, pathogenesis, multimodal imaging characteristics, etiologies, and natural course of vitelliform maculopathies.
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Affiliation(s)
- Claudio Iovino
- Eye Clinic, Multidisciplinary Department of Medical, Surgical and Dental Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Prithvi Ramtohul
- Vitreous Retina Macula Consultants of New York, New York, NY, USA
| | - Adrian Au
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Veronica Romero-Morales
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - SriniVas Sadda
- Doheny Image Reading Center, Doheny Eye Institute, University of California Los Angeles (UCLA) Affiliated, Los Angeles, CA, USA; Department of Ophthalmology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York, New York, NY, USA; Department of Ophthalmology, NYU Grossman School of New York, New York, NY, USA
| | - David Sarraf
- Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USA; Greater Los Angeles Veterans Affairs Healthcare Center, Los Angeles, CA, USA.
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Brinkmann M, Bacci T, Kar D, Messinger JD, Sloan KR, Chen L, Hamann T, Wiest M, Freund KB, Zweifel S, Curcio CA. Histology and Clinical Lifecycle of Acquired Vitelliform Lesion, a Pathway to Advanced Age-Related Macular Degeneration. Am J Ophthalmol 2022; 240:99-114. [PMID: 35192790 PMCID: PMC9592119 DOI: 10.1016/j.ajo.2022.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate hypotheses about the role of acquired vitelliform lesion (AVL) in age-related macular degeneration pathophysiology. DESIGN Laboratory histology study; retrospective, observational case series. METHODS Two donor eyes in a research archive with AVL and age-related macular degeneration were analyzed with light and electron microscopy for AVL content at locations matched to ex vivo B-scans. A retrospective, observational clinical cohort study of 42 eyes of 30 patients at 2 referral clinics determined the frequency of optical coherence tomography features stratified by AVL fate. RESULTS Histologic and clinical cases showed subretinal drusenoid deposit and drusen. Ultrastructural AVL components in 2 donor eyes included retinal pigment epithelium (RPE) organelles (3%-22% of volume), outer segments (2%-10%), lipid droplets (0.2%-12%), and a flocculent material (57%-59%). Of 48 AVLs (mean follow-up 46 ± 39 months), 50% collapsed to complete RPE and outer retinal atrophy, 38% were stable, 10% resorbed, and 2% developed neovascularization. The Early Treatment Diabetic Retinopathy Study grid central subfield contained 77% of AVLs. Hyperreflective foci, ellipsoid zone disruption, and hyperreflective thickening of the RPE-basal lamina-Bruch membrane band were common at maximum AVL expansion. Collapsing and noncollapsing AVLs had different growth rates (rapid vs slow, respectively). CONCLUSIONS AVL deposits contain unexpectedly low levels of RPE organelles and outer segments. Subfoveal predilection, reflectivity on optical coherence tomography, hyperautofluorescence, yellow color, and growth-regression phases suggest dysregulation of lipid transfer pathways specific to cone photoreceptors and supporting cells in formation of AVL deposit, analogous to drusen and subretinal drusenoid deposit. Prediction of AVL outcomes via growth rates should be confirmed in larger clinical studies.
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Affiliation(s)
- Max Brinkmann
- Department of Ophthalmology and Visual Sciences (M.B., D.K., J.D.M., K.R.S., L.C., C.A.C.), University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA; Department of Ophthalmology (M.B., T.H., M.W., S.Z.), University Hospital Zurich, Zurich, Switzerland
| | - Tommaso Bacci
- Vitreous Retina Macula Consultants of New York (T.B., K.B.F.), New York University School of Medicine, New York, New York, USA
| | - Deepayan Kar
- Department of Ophthalmology and Visual Sciences (M.B., D.K., J.D.M., K.R.S., L.C., C.A.C.), University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Jeffrey D Messinger
- Department of Ophthalmology and Visual Sciences (M.B., D.K., J.D.M., K.R.S., L.C., C.A.C.), University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Kenneth R Sloan
- Department of Ophthalmology and Visual Sciences (M.B., D.K., J.D.M., K.R.S., L.C., C.A.C.), University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Ling Chen
- Department of Ophthalmology and Visual Sciences (M.B., D.K., J.D.M., K.R.S., L.C., C.A.C.), University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA; First Affiliated Hospital of Chongqing Medical University (L.C.), Chongqing Key Laboratory of Ophthalmology, and Chongqing Eye Institute, Chongqing, China
| | - Timothy Hamann
- Department of Ophthalmology (M.B., T.H., M.W., S.Z.), University Hospital Zurich, Zurich, Switzerland
| | - Maximilian Wiest
- Department of Ophthalmology (M.B., T.H., M.W., S.Z.), University Hospital Zurich, Zurich, Switzerland
| | - K Bailey Freund
- Vitreous Retina Macula Consultants of New York (T.B., K.B.F.), New York University School of Medicine, New York, New York, USA; LuEsther T. Mertz Retinal Research Center (K.B.F.), New York University School of Medicine, New York, New York, USA; Manhattan Eye, Ear and Throat Hospital, and the Department of Ophthalmology (K.B.F.), New York University School of Medicine, New York, New York, USA
| | - Sandrine Zweifel
- Department of Ophthalmology (M.B., T.H., M.W., S.Z.), University Hospital Zurich, Zurich, Switzerland; Department of Ophthalmology, University of Zurich (S.Z.), Zurich, Switzerland
| | - Christine A Curcio
- Department of Ophthalmology and Visual Sciences (M.B., D.K., J.D.M., K.R.S., L.C., C.A.C.), University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
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