Multifocal Macular Lesions in a Middle-aged Woman

A 49-year-old African American woman with no significant medical history came to the clinic because of abnormal retinal findings and mildly decreased visual acuity. She was told about these same findings 10 years ago but did not have a repeated eye examination until recently by another retina specialist. She reported no family history of retinal diseases. She initially received anti–vascular endothelial growth factor (VEGF) treatment, but was later referred because of a concern about either the idiopathic or paraneoplastic variant of acute exudative polymorphous vitelliform maculopathy (AEPVM). Initial workup by her primary care physician was unremarkable for malignancy. Her best-corrected visual acuity (BCVA) was 20/60 OD and 20/50 OS. An anterior segment examination was normal. Dilated fundus examination revealed multiple vitelliform lesions involving the macula and superior macula bilaterally (Figure 1). Fluorescein angiography revealed staining of these lesions with a pseudohypopyon appearance of the central vitelliform lesion in the left eye. Optical coherence tomography (OCT) showed hyperreflectance corresponding to the yellow pigment in the vitelliform lesions in the subretinal space. No evidence of a choroidal neovascular membrane was present on examination or imaging.