Fundus examinations of a 55-year-old male patient demonstrated a round, elevated yellowish lesion centered by a pigmented spot, widespread intraretinal microaneurysms and dot-blot hemorrhages with a small number of hard exudates in both eyes. Spectral-domain optical coherence tomography scans of both eyes disclosed that the fovea was raised by a hyperreflective material which was located between the retina pigment epithelium and the photoreceptor layer with a persistent posterior hyaloid attachment exerting adhesion on the fovea in the both eyes. Moreover, multiple hyperreflective retinal dots which had shadowing effects and cystoid macular edema without subretinal fluid were also detected in optical coherence tomography images.
Additionally, fundus autofluorescence imaging demonstrated that the vitelliform lesions were hyper-autofluorescence in the fovea which were compatible with accumulation of lipofuscin while the hemorrhages were seen as hypo-autofluorescence dots in both eyes.
Fundus fluorescein angiography could not be performed as the patient had chronic renal failure.
Adult-onset foveomacular vitelliform dystrophy is a rare disease characterized by a round subretinal deposit of yellowish material located in the macular area but the exact location of the vitelliform material has not been fully elucidated. Diabetic cystoid macular edema may rarely accompany adult-onset foveomacular vitelliform dystrophy; optical coherence tomography and fundus autofluorescence are helpful diagnostic imaging techniques to identify this condition.
Credit: Kemal Tekin, M.D., from Ulucanlar Eye Training and Research Hospital
Instagram accounts: @retina.academy and @dr.kemaltekin
