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Pachyvitelliform maculopathy: an optical coherence tomography analysis of a novel entity
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  • Published on:
    Pachychoroid and vitelliform deposits
    • Salomon Y Cohen, Ophthalmologist Centre Ophtalmologique d'Imagerie et de Laser, Paris, France
    • Other Contributors:
      • Alain Gaudric, Ophthalmologist
      • Sarah Mrejen, Ophthalmologist

    Dear Editor, we read with interest the study of Hilely and coworkers, describing a new condition which they referred to as pachyvitelliform maculopathy. Their study clearly demonstrates the association between pachychoroid features and adult vitelliform lesions (AVLs).1 Two previous reports by our teams may stregthen their hypothesis of a relationship between the two conditions. In cuticular drusen, we have shown that vitelliform detachments occur significantly more often in eyes with a thick choroid, and we suggested that the choroidal vasculature could play a role in the occurrence of macular detachments in patients with cuticular drusen, leading to accumulation of photreceptors debris and deposits.2 More recently, we report a series of 49 eyes with hyperreflective vertical lines diagnosed on B-scans of spectral-domain optical coherence tomography. Twenty-four eyes presented with AVLs related to adult vitelliform dystrophy or pattern dystrophy. We were surprised that, in 14 cases out of 24, signs of pachychoroid were present. We suggested that further studies were needed to better understand this relationship.3 So we fully agree in that the pachychoroid syndrome may interfere with the metabolism of the retinal pigment epithelium and the phagocytosis process, leading to accumulation of photoreceptors debris. We really thank Hilely and coworkers for their convincing step towards a better recognition of this curious association.

    Salomon Y Cohen, A Gaudric, Sarah Mrej...

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    Conflict of Interest:
    None declared.
  • Published on:
    Rapid response to "Pachyvitelliform maculopathy: optical coherence tomography analysis of a new entity"
    • Beatrice Tombolini, Opthalmology Resident Vita-Salute San Raffaele University, Milan (Italy)

    We read with considerable attention the manuscript by Hilely et al. entitled “Pachyvitelliform maculopathy: an optical coherence tomography analysis of a novel entity.”1 We would like to compliment the Authors on their great effort and excellent figures.
    Hilely and associated introduced a novel clinical entity named pachyvitelliform maculopathy (PVM). It consisted of the association between acquired vitelliform lesion (AVL) and pachychoroid disease spectrum (PDS) features, including pachychoroid (choroidal thickness > 250 μm), pachyvessels (dilated Haller vessels), and inner choroid thinning. In detail, a yellowish hyperreflective lesion overlayed a thick choroid and pachyvessels. In contrast to other forms PDS,2 PVM displayed no subretinal (SRF) or intraretinal fluid (IRF) and neovascularization. Furthermore, cases of pachychoroid and drusen (medium, large, cuticular, pseudo reticular, and subretinal drusenoid deposits) were excluded. This condition was described in 60 years older subjects with electro-oculogram within normal range and with a negative genetic test, although performed in a minority of the cohort.
    We would like to have the thoughts about the following issue that Hilely and colleagues ought to address. Although the Authors stated that this was the first description of PVM, previous papers discussed the aforementioned association between PDS and vitelliform lesions. In detail, Spaide described three cases (two monoliteral, and one bilateral) o...

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    Conflict of Interest:
    None declared.