Macular vitelliform degeneration in adults: Indocyanine green angiographic findings

Purpose: The adult macular vitelliform degeneration (AMVD) is a macular disease similar to Best vitelliform dystrophy, but occuring in adults with normal or subnormal electro-oculogram. It is characterized by the accumulation of lipofuscin-like material within and beneath the retinal pigment epithelium. The aim of this study was to analyze the choroidal perfusion and permeability in patients with AMVD. Methods: We retrospectively analyzed dynamic and still-frame indocyanine green angiographies (ICGA) in 40 consecutive patients with AMVD (64 eyes). We studied the pattern of choroidal filling at the posterior pole in the early phases of the dynamic ICGA performed with a SLO (Rodenstock, Germany), and the alterations of the choroidal permeability observed with a still-frame ICGA digitized fundus camera (Topcon 50 IA, Japan). Results: The choroidal filling appeared normal in all patients. In 29 patients (52 eyes) ICGA revealed choroidal vascular hyperpermeability seen as areas of hyperfluorescence that were detectable at the posterior pole in the mid and late phases of the angiogram. The choroidal hyperpermeability was often present in the fellow eye even though no subretinal macular material was evident. Conclusion: The angiographic changes observed in these patients with adult macular vitelliform degeneration seem to underline an important pathogenetic role of the choroidal vasculature. The interpretation of the detected choroidal hyperpermeability, common to other diseases, such as central serous chorioretinopathy, still needs to be clarified.