Acquired Vitelliform Lesions in Intermediate Age-Related Macular Degeneration: A Cross-Sectional Study

Purpose This study aims to define the characteristics of acquired vitelliform lesions (AVLs) in patients with intermediate age-related macular degeneration (iAMD). Design Retrospective, observational, cross-sectional study Subjects This study included 217 eyes with AVLs associated with iAMD, and an equivalent number of control patients. Methods Optical coherence tomography (OCT) scans were evaluated for qualitative and quantitative parameters at both the eye and lesion level. Eye-level parameters included the presence of: hyporeflective core drusen, intraretinal hyperreflective foci (IHRF), subretinal drusenoid deposits, macular pachyvessels, central retinal thickness, and central choroidal thickness (CCT). Lesion-level qualitative parameters included the presence of ellipsoid zone (EZ) and external limiting membrane disruption overlying the AVL, IHRF overlying the AVL, AVL overlying drusen, pachyvessels under the AVL, a solid core within AVL, and AVL location. Lesion-level quantitative characteristics included AVL height and width, AVL distance from the fovea, and sub-AVL choroidal thickness. Main Outcome Measures The primary outcomes assessed included the frequency of iHRF, the presence of macular pachyvessels, CCT, and the dimensions (both height and width) of AVLs. Results Comparing the AVL and control groups, the frequency of IHRF (AVL: 49.3% vs. control: 26.3%) and macular pachyvessels (37.3% vs. 6.9%) was significantly higher in the AVL case group, and the CCT (256.8 ± 88 μm vs. 207.1± 45 μm) was thicker in the AVL group. AVL lesions located over drusen, with overlying IHRF, or situated subfoveally, and AVL lesions with EZ disruption were found to have a greater lesion height and width compared to AVL lesions lacking these characteristics (P-value < 0.001 for all). Additionally, a significant negative correlation was observed between the distance from the fovea and AVL height (Spearman's rho: -0.19, P = 0.002) and width (Spearman’s rho: -0.30, P = 0.001). Conclusions This study represents the largest reported cohort of AVL lesions associated with iAMD. Novel findings include the higher frequency of pachyvessels in addition to the presence of a thicker choroid in these eyes, as well as the greater height and width of AVL closer to the foveal center. These findings may offer insights into pathophysiologic mechanisms underlying the development of AVL.