Multimodal Imaging of Acquired Vitelliform Lesion Diagnosed at Pseudohypopyon Stage

Purpose. To present a case study of a monocular acquired vitelliform lesion, studied with multimodal fundus imaging (spectral-domain-optical coherence tomography, fundus autofluorescence, and fluorescein angiography) with a followup of three years. Case Report. An asymptomatic macular lesion was detected on a 64-year-old man. Fundus exam revealed a macular lesion with an apparent horizontal level associated with multiple round small whitish lesions, suggestive of cuticular drusen. He was studied with autofluorescence of the fundus (FAF), fluorescein angiography (FA), spectral domain-optical coherence tomography (SD-OCT), and electrooculogram. The findings were compatible with the diagnosis of acquired vitelliform lesion, associated with cuticular drusen. After one year, the visual acuity decreased to 20/50, without identifiable alterations of the FAF, FA, or SD-OCT. Three years later, fundoscopy and imaging showed an evolution to a state similar to vitelli disruptive phase of Best disease with an improvement of visual acuity to 20/25. We report the results of FAF, FA, and SD-OCT at this stage. Conclusion. Acquired vitelliform lesions associated with cuticular drusen can present as a pseudohypopyon lesion, and the evolution to the atrophic phase can be associated with an improvement of visual acuity. 1. Introduction The term vitelliform lesions refers to accumulation of yellowish subretinal material. In younger patients, they usually occur in the setting of Best vitelliform macular dystrophy, an autosomal dominant disorder, associated with mutations in bestrophin 1 gene [1]. In adults, vitelliform lesions can occur associated with various disorders: age-related macular degeneration, cuticular drusen, or tractional maculopathies [1]. The classical staging of Best vitelliform macular dystrophy divides the progression of the disease into five stages: subclinical, vitelliform, pseudohypopyon, vitelliruptive, and atrophic [2]. These stages are also observed in acquired lesions; however, the pseudohypopyon stage is rarely identified. The case report we present shows a multimodal image study of an acquired vitelliform lesion, associated with cuticular drusen, diagnosed in the stage of pseudohypopyon. 2. Case Presentation In April 2009, a 64-year-old man was referred to the Retina Department to study a macular lesion OS. There was the suspicion of a choroidal neovascular lesion. The patient had a history of trauma to OD during childhood, with resulting traumatic cataract, exotropia, and amblyopia of OD. He had undergone phacoemulsification with insertion of an