Article

9 Iconography
Access to the text (HTML) Access to the text (HTML)
PDF Access to the PDF text
Service d'aide à la décision clinique
Advertising


Access to the full text of this article requires a subscription.
  • If you are a subscriber, please sign in 'My Account' at the top right of the screen.

  • If you want to subscribe to this journal, see our rates



Journal Français d'Ophtalmologie
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le vendredi 6 mars 2020
Doi : 10.1016/j.jfo.2020.01.004
Received : 31 December 2019 ;  accepted : 23 January 2020
Eight-year multimodal follow-up of recurrent idiopathic acute exudative polymorphous vitelliform maculopathy
 

Y.S. Astakhov, S.Y. Astakhov, A.B. Lisochkina, P.A. Nechiporenko
 Pavlov First Saint Petersburg State Medical University, St Petersburg, Russia 

Corresponding author.
Summary
Purpose

To describe and analyze clinical findings in a patient with recurrent idiopathic acute exudative polymorphous vitelliform maculopathy (AEPVM), followed in detail, and to propose the diagnostic and follow-up algorithm.

Design

Retrospective observational analysis.

Patient

A young adult male patient diagnosed with idiopathic AEPVM who developed two relapses in a 12-month period eight years after the initial onset.

Methods

Review of clinical charts, multimodal imaging, and electrophysiology findings. The patient repeatedly underwent complete ophthalmic examinations, including best-corrected visual acuity testing (BCVA), slit-lamp and fundus examinations; digital fundus photography, time-domain optical coherence tomography (OCT) in 2009 (Stratus OCT, Carl Zeiss Meditec, USA) and spectral-domain OCT in 2017–2018 (Spectralis-OCT, Heidelberg Engineering, Germany), together with fundus autofluorescence (FAF), fluorescein angiography (FA), and indocyanine green angiography (ICGA), all with HRA2 (Heidelberg Engineering, Germany); microperimetry (MP-1 microperimeter, Nidek, Japan). Laser flare photometry (Kowa FM-600, Japan) and electrophysiology testing were also performed.

Main outcome measures

Clinical features of long-lasting recurrent idiopathic AEPVM, and diagnostic and follow-up algorithm in such rare cases.

Results

Case report of a 25-year-old male Caucasian patient with typical features of AEPVM, including serous neuroepithelial detachment with irregular retinal elevations, ophthalmoscopically resembling retinal folds, with subsequent subretinal accumulation of characteristic yellow–white vitelliform deposits. Features in this case rarely described, or even not yet reported, include indocyanine- and fluorescein-negative intraretinal cystic changes, optic disc hyperfluorescence on FA, serous retinal elevations mimicking retinal folds, increased choroidal thickness, lack of rapid visual recovery, and very slow anatomical improvement of the relapses. Bimonthly fundus autofluorescence evaluation together with SD-OCT were the most informative diagnostic methods, demonstrating the evolution of pathological signs.

Conclusion

AEPVM may be a recurrent or even chronic condition with uncertain long-term visual outcomes. It may have variable clinical presentations depending on the stage of the disease, and both clinical manifestations and imaging features of different stages of the pathologic process may overlap. Patients should be made aware that visual improvement occurs very slowly, if at all. Bimonthly fundus autofluorescence evaluation together with SD-OCT should be recommended in such cases.

The full text of this article is available in PDF format.

Keywords : Recurrent, Idiopathic, Acute, Exudative, Polymorphous, Vitelliform, Maculopathy, Intraretinal fluid, Subretinal fluid, Subretinal deposits, Lipofuscin, Imaging, Fluorescein angiography, Fundus autofluorescence, Indocyanine green angiography, Microperimetry, Laser flare photometry, Multimodal imaging, Long-term evaluation

Abbreviations : AEPVM, EDI, FA, FAF, ICGA, mfERG, OD, OS, RPE, SD-OCT




© 2020  Elsevier Masson SAS. All Rights Reserved.
EM-CONSULTE.COM is registrered at the CNIL, déclaration n° 1286925.
As per the Law relating to information storage and personal integrity, you have the right to oppose (art 26 of that law), access (art 34 of that law) and rectify (art 36 of that law) your personal data. You may thus request that your data, should it be inaccurate, incomplete, unclear, outdated, not be used or stored, be corrected, clarified, updated or deleted.
Personal information regarding our website's visitors, including their identity, is confidential.
The owners of this website hereby guarantee to respect the legal confidentiality conditions, applicable in France, and not to disclose this data to third parties.
Close
Article Outline