Progression of an Acquired Vitelliform Lesion to a Full-Thickness Macular Hole Documented by Eye-Tracked Spectral-Domain Optical Coherence Tomography

Vitelliform lesions (VLs), classically seen in young patients in autosomal dominant Best disease, are also seen as acquired lesions in entities such as adult-onset foveomacular vitelliform dystrophy, cuticular drusen, and central serous chorioretinopathy. These lesions appear as round yellowish deposits of material exhibiting hyperautofluorescence with fundus autofluorescence imaging. Spectral-domain optical coherence tomography (SD-OCT) shows hyperreflective material in the subretinal space, often with focal thickening at the level of the retinal pigment epithelium.¹ The natural course of these lesions is often a gradual reduction in lesion size with fragmentation and resorption of the vitelliform material and eventual photoreceptor disruption and atrophy with accompanying hypoautofluorescence.² A few studies have shown the development of a macular hole (MH) in eyes with VLs due to Best disease or adult-onset foveomacular vitelliform dystrophy.^3- 4 Herein, we report the first case to our knowledge showing with eye-tracked SD-OCT the evolution of an acquired VL (AVL) to a full-thickness MH in the absence of vitreomacular traction or an epiretinal membrane.