Delhi Journal of Ophthalmology

Optical Coherence Tomography of Adult-Onset Foveomacular Vitelliform Dystrophy Concomitant with Diabetic Cystoid Macular Edema

Kemal Tekin, Mehmet Murat Uzel, Mehmet Yasin Teke
Ankara Ulucanlar Eye Training and Research Hospital, Ankara, Turkey

Corresponding Author:

Kemal Tekin
Ulucanlar Cad. No: 59 06230
Altindag/Ankara/Turkey
Email id: kemal_htepe@hotmail.com

Received: 11-DEC-2018

Accepted: 16-JAN-2019

Published Online: 05-MAY-2019

DOI:http://dx.doi.org/10.7869/djo.458

Abstract
Purpose: To report an unusual appearance on Spectralis optical coherence tomography (OCT) finding: bilateral adult-onset foveomacular vitelliform dystrophy (AFVD) concomitant with diabetic cystoid macular edema.
Case Description: Fundus examination of a 55 year-old 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 the both eyes. OCT scans of both eyes disclosed that the foveal retina 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 revealed in OCT images. Additionally, fundus autofluorescence (FAF) 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.
Conclusion: Diabetic cystoid macular edema may rarely accompany AFVD; OCT and FAF are helpful diagnostic imaging techniques to identify this condition.

Keywords :Adult-onset foveomacular vitelliform dystrophy, Diabetic cystoid macular edema, Optical coherence tomography



Optical coherence tomography (OCT) is a noninvasive technique for diagnosis and monitoring of macular diseases which provides optical cross sectional images of the retina and morphological information close to that obtained from histopathological sections.1 Adult-onset foveomacular vitelliform dystrophy (AFVD) 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.2-4 Although features of AFVD have already been evaluated by OCT, a concomitant case of AFVD and diabetic cystoid macular edema has not been reported before. 
Herein, we report a 55 year-old female with an unusual appearance on Spectralis OCT: bilateral AFVD concomitant with diabetic cystoid macular edema. Fundus examination of the 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 the both eyes. OCT scans of both eyes disclosed that the foveal retina was raised by a hyperreflective material which was located between the retinal pigment epithelium and the photoreceptor layer with a persistent posterior hyaloid attachment exerting adhesion on the fovea in the both eyes (Figures 1 and 2). 



Moreover, as illustrated in Figures 1 and 2, multiple hyperreflective retinal dots which had shadowing effects and cystoid macular edema without subretinal fluid were revealed in OCT images. Additionally, fundus autofluorescence (FAF) 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 (Figures 3 and 4). Fundus fluorescein angiography could not be performed because of a previous history of allergy. As a conclusion, diabetic cystoid macular edema may rarely accompany AFVD; OCT and FAF are helpful diagnostic imaging techniques to identify this condition. Informed consent: Informed consent was obtained from the patient included in the study.




References
1. Adhi M, Duker JS. Optical coherence tomography—current and future applications. Curr Opin Ophthalmol 2013; 24:213-221.
2. Do P, Ferrucci S. Adult-onset foveomacular vitelliform dystrophy. Optometry 2006; 77:156-166.
3. Benhamou N, Souied EH, Zolf R, Coscas F, Coscas G, Soubrane G.
Adult-onset foveomacular vitelliform dystrophy: a study by optical coherence tomography. Am J Ophthalmol 2003; 135:362-367.
4. Pierro L, Tremolada G, Introini U, Calori G, Brancato R. Optical coherence tomography findings in adult-onset foveomacular vitelliform dystrophy. Am J Ophthalmol 2002; 134:675-680.


CITE THIS ARTICLE

Kemal Tekin, Mehmet Murat Uzel, Mehmet Yasin TekeOptical Coherence Tomography of Adult-Onset Foveomacular Vitelliform Dystrophy Concomitant with Diabetic Cystoid Macular Edema.DJO 2019;29:102-103

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Kemal Tekin, Mehmet Murat Uzel, Mehmet Yasin TekeOptical Coherence Tomography of Adult-Onset Foveomacular Vitelliform Dystrophy Concomitant with Diabetic Cystoid Macular Edema.DJO [serial online] 2019[cited 2019 May 22];29:102-103. Available from: http://www.djo.org.in/articles/29/4/Optical-Coherence-Tomography-of-Adult-Onset-Foveomacular-Vitelliform-Dystrophy-Concomitant-with-Diabetic-Cystoid-Macular-Edema.html