Age Related Macular Degeneration - Vitelliform lesion with RPE tear and scarring
These images come from an 84-year-old patient with a history of age-related macular degeneration (AMD). In his right eye, he has a thick scar from the progression of AMD (red arrow) as well as a retinal pigment epithelium tear (green arrows). The whitening seen in his right retina is his sclera revealed by the RPE tear (black arrows). Furthermore, he has adult vitelliform lesions in both eyes (white arrows). These round solitary lesions are usually bilateral and asymptomatic. They appear yellow due to the accumulation of waste deposits in the fovea. Adult vitelliform dystrophy is an inherited condition that is milder than AMD. These lesions do not connote that the patient has two conditions (AMD plus adult vitelliform dystrophy). Rather, adult vitelliform lesions can occur as part of AMD. In his left eye optical coherence tomography scan, a hyperreflective epiretinal membrane (wrinkling of the retina) is also noticeable (yellow arrow). His visual acuity at the time of these photographs was count fingers in his right eye and 20/25 in his left. There is no treatment for adult vitelliform lesions at this time. But he takes the Age Related Eye Disease II vitamins to reduce the chance of progression of the left eye to neovascular macular degeneration. He received a series of intravitreal injections of anti- vascular endothelial growth factors drugs (aflibercept and bevacizumab) for the right eye until the vision dropped to the count fingers range at which time injections were halted.