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  • Macular Atrophy Progression With Acquired Vitelliform Lesions

    By Jean Shaw
    Selected by Andrew P. Schachat, MD
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    Journal Highlights

    Ophthalmology Retina, March 2022

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    Chandra et al. set out to evaluate the risk of developing macular atrophy (MA) in eyes with acquired vitelliform lesions (AVLs). They found that approximately 20% of eyes with AVLs develop MA by the end of five years of follow-up. In addition, they found that eyes with poor visual acuity (VA) at baseline, external limiting membrane (ELM) loss or disruption, subretinal drusen deposits (SDDs), pseudohypopyon or vitelliruptive lesions, and large lesions are at greater risk of developing MA.

    For this retrospective observa­tional study, the researchers assessed 132 patients (237 eyes). The patients’ mean age was 66.5 years, and 53.8% were female. Spectral-domain OCT and fundus autofluorescence (FAF) scans were graded and analyzed, and multivariable hazard models were used to assess potential risk factors for MA after adjustment for age and gender.

    By five years, incident MA was detected in 52 eyes (21.9%). When stratified by baseline VA, 4.3% of the 131 eyes with VA of 20/40 or worse developed atrophy within five years, versus 1.3% of the 106 eyes with VA better than 20/40 (p < .0001). Based on lesion type, 12.9% of eyes with vitel­liform lesions at baseline developed MA, versus 39.8% and 44.2% of eyes with pseudohypopyon or vitelliruptive lesions, respectively.

    In adjusted analysis, baseline factors associated with increased risk of MA included VA of 20/40 or worse (hazard ratio [HR] 5.54; confidence interval [CI] 95%, 2.30-13.34), lesion base width (HR, 1.22; 95% CI, 1.16-1.28), lesion height (HR, 2.61; 95% CI, 1.82-3.74), presence of SDDs (HR, 2.83; 95% CI, 1.34-5.96), and disrupted ELM (HR, 2.81; 95% CI, 1.34-5.86).

    Given these findings, the authors said, patients with relevant risk factors should be counseled about potential visual loss from MA. In contrast, those with good baseline VA can be followed up at longer intervals.

    The original article can be found here.