Arnold J J, Sarks J P, Killingsworth M C, Kettle E K, Sarks S H
Marsden Eye Centre Sydney, Australia.
Eye (Lond). 2003 Aug;17(6):717-26. doi: 10.1038/sj.eye.6700460.
AIMS/BACKGROUND: The yellow lesions of adult vitelliform macular degeneration (AVMD) slowly fade, progressing to hyperpigmentation or atrophy. This study aims to provide further observations on the location and nature of the vitelliform material.
This report describes the clinicopathological correlation of four eyes with AVMD. A retrospective histopathological study of a further 526 aged eyes previously graded for the stage of age-related macular degeneration (AMD) found another 10 eyes with similar pathology.
The predominant finding was a collection of extracellular material beneath the sensory retina at the fovea. This material was derived internally from photoreceptor outer segments and externally from the retinal pigment epithelium (RPE), the latter first undergoing hypertrophy and then disruption and attenuation. Fallout of foveal cones occurred over these lesions and the inner retina was thinned, which may explain macular hole formation in this condition. All affected eyes showed histopathological evidence of AMD.
This study confirms that the vitelliform lesions of AVMD lie beneath the sensory retina. In contrast to previous reports, however, it is proposed that the lesions comprise mainly extracellular material consisting of photoreceptor debris, possibly the result of faulty phagocytosis by the RPE, mixed with pigment liberated as the RPE undergoes disruption. The vitelliform lesions therefore are a marker for the area of maximal RPE disturbance.
目的/背景：成人卵黄样黄斑变性（AVMD）的黄色病变会逐渐消退，进而发展为色素沉着或萎缩。本研究旨在对卵黄样物质的位置和性质提供进一步的观察结果。
本报告描述了4例AVMD患者眼部的临床病理相关性。对另外526只曾根据年龄相关性黄斑变性（AMD）分期进行分级的老年眼进行回顾性组织病理学研究，发现另外10只眼具有相似的病理表现。
主要发现是在黄斑中心凹的感觉视网膜下方有细胞外物质聚集。这种物质内部来源于光感受器外节，外部来源于视网膜色素上皮（RPE），后者首先发生肥大，然后破裂和萎缩。黄斑中心凹视锥细胞在这些病变上脱落，视网膜内层变薄，这可能解释了这种情况下黄斑裂孔的形成。所有受累眼均显示有AMD的组织病理学证据。
本研究证实AVMD的卵黄样病变位于感觉视网膜下方。然而，与先前的报告不同，本研究提出这些病变主要由细胞外物质组成，包括光感受器碎片，这可能是RPE吞噬功能异常的结果，同时混有RPE破裂时释放的色素。因此，卵黄样病变是RPE最大程度紊乱区域的一个标志。
