Adult Vitelliform Lesion developing Macular Hole

These are images of a 69 year old female with an adult vitelliform lesion (AVL) in the setting of age-related macular degeneration. The lesion evolved into full-thickness macular hole with retinal pigment atrophy (RPE) in the base. The OCT scans show the progression of the lesion from an AVL to a lamellar and ultimately full thickness macular hole (red brackets). An AVL represents an accumulation of cellular waste deposits subjacent to the fovea. The toxic effect of the deposits has led to an area of outer retinal cavitation (yellow arrows) adjacent to a full thickness macular hole. Vitrectomy, internal limiting membrane peeling, and gas-fluid exchange can close the macular hole. However, it will not change the vitelliform lesion. A table of her visual acuities over time follows. +-----------+-----------+ | Date | VA | +-----------+-----------+ | 6-27-2014 | 20/50 +2 | +-----------+-----------+ | 8-21-2015 | 20/80 | +-----------+-----------+ | 8-23-2016 | 20/200 | +-----------+-----------+ | 8-25-2017 | 20/100 | +-----------+-----------+ | 9-4-2018 | 20/160 -2 | +-----------+-----------+