Introduction. Vitelliform lesions of the central retinal area in adult patients represent a heterogeneous group of diseases. This article describes different variants of vitelliform changes in adults, based on the published literature data. Materials and methods. We have analyzed and described different variants of vitelliform changes in adults, based on literature data, examples from own clinical practice using multimodal approach are included. Discussion. Vitelliform lesions of the central retinal area are can debut at various ages, occurring in mono- or multifocal way, have various stages of degradation of vitelliform material, masquerading as other lesions of the macular area and of the posterior pole. Many of these diseases appear due to mutations in determined genes, though, a fairly large proportion of cases is considered to be sporadic. Nowadays, characteristic signs of different diseases with the vitelliform material are described. But differential diagnosis with other similar diseases (some age-related macular degeneration forms and those of central serous chorioretinopathy) is fairly difficult and requires a multimodal ophthalmologic approach, and in some cases genetic studies. Conclusions. Vitelliform lesions of the central retinal area, occurring in adult patients are a group of diseases that are difficult to diagnose and masquerade themselves as other diseases of the central retina, which requires certain doctors knowledge and ability to carry out a multimodal imaging and prescribe the appropriate treatment if needed.
AIM: To study predictors in order to optimize the differential diagnosis of persistent central serous chorioretinopathy (CSCR) and different forms of vitelliform dystrophies occurring in adults. MATERIALS AND METHODS: Ninety eyes of 61 patients with long-term serous retinal detachments were recruited in study. All patients underwent ophthalmologic examination including family history, best corrected visual acuity, biomicroscopy, and multimodal imaging including fundus photo, SD-OCT, OCT-A, BAF, FA, ICGA. After the studies, the patients were divided into two groups: with vitelliform dystrophies 30 eyes of 30 patients and with CSCR 31 eyes of 31 patients. Diagnostic predictors found in both groups were scrutinized, mathematical models were obtained, and their recognition quality was assessed by the area under ROC curve. The criteria for all types of research were studied and the predictive value was assessed with the use of ROC analysis. RESULTS: The most informative non-invasive predictors for the diagnosis of vitelliform dystrophies occurring in adults are the following: a positive family history of the disease, brightness and gradient of hyperautofluorescence (hyperAF), typical hyperAF in the form of a crescent and beads, the presence of massive subretinal deposits and deposits in the form of stalactites. The most informative non-invasive predictors for the diagnosis of persistent CSCR are the following: additional hypoAF or hyperAF points or areas outside the main focus, hyperreflective dots in the neurosensory retina and an increase in choroidal thickness, irregular pigment epithelial detachments, presence of CNV. The highest predictive value for both groups was determined for BAF studies. CONCLUSIONS: The results obtained make it possible to optimize the differential diagnosis of persistent CSCR and different forms of vitelliform dystrophies occurring in adults.
Purpose.To optimize the differential diagnosis of chronic central serous chorioretinopathy (CSCR) and of adult-onset vitelliform dystrophies (VD). Research objectives. On the multimodal diagnosis basis, to investigate signs characteristic for VD and chronic CSCR using mathematic modeling, to elaborate algorithms of their differential diagnosis in settings of differently equipped clinics. Materials and methods.61 patient (90 eyes) with long-term neuroepithelial detachments (NEDs) were included in the study. In all patients, the disease history was collected, including the family history; all patients underwent a standard ophthalmologic examination: visual acuity testing including best corrected visual acuity (BCVA), biomicroophthalmoscopy, fundus photography, spectral domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCT-A), short-wavelength autofluorescence (SW-AF), fluorescein angiography (FA), indocyanine green angiography (ICGA). Patients were divided into two groups: with vitelliform dystrophies 30 patients (30 eyes), and with CSCR 31 patients (31 eyes). To estimate the probability of disease detection, binary logistic regression method was used. Results.Diagnostic predictors found in both groups were scrutinized; mathematical models for estimating the probability of disease detection were obtained. Differential diagnostics algorithms have been developed taking into account the resulting formulas for calculating the probability of disease detection, including criteria of different examination combinations: SD-OCT (area under ROC curve 0.946); BAF (area under ROC curve 0.955), SD-OCT and SW-AF (area under ROC curve 0.980); SW-AF, FA and ICGA (area under ROC curve 0.989). Conclusion.The obtained models make it possible to carry out differential diagnosis of vitelliform dystrophies and chronic CSCR in settings of differently equipped clinics.
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