IMAGE OF THE MONTH: Q1 2026
Asymptomatic Bilateral Bumps
Case
A 36-year-old man referred for abnormal fundus findings seen on routine eye exam. Visual acuity is 20/20 bilaterally and he is asymptomatic. The fundus images and autofluorescence findings are presented below. What is the diagnosis?
Diagnosis
Diagnosis: Multifocal Vitelliform Paravascular Retinopathy (MVPR)
Discussion
Retinal evaluation revealed multiple well delineated vitelliform lesions near the superior arcade in both eyes. These lesions were classic vitelliform in appearance with multifocal small, round, yellow lesions with distinct borders, brightly hyperfluorescent on fundus autofluoresence. OCT through some of the lesions in the right eye confirmed the presence of subretinal hyperreflective material. As these lesions are predominantly near or outside of the arcades, the patient is asymptomatic with 20/20 acuities in each eye.
The patient had a history of hypertension on amlodipine and losartan. He has borderline high cholesterol levels (LDL) but not yet warranting initiation of systemic therapy. The patient denied any family history of known retinal disorders. Given the imaging findings, and clinical background, a diagnosis of multifocal vitelliform paravascular retinopathy (MVPR) was made. The patient has been followed for 2 years without marked evolution of the findings.
MVPR is a relatively new entity of vitelliform spectrum disorders. Due to the heterogeneity of the index case series on this condition, little is yet established on as causal associations with the presenting phenotype. There was a large age-range in this initial case series ranging from 10-78, without clear common link for etiology. None of the patients in the initial case series experienced vision loss as the vitelliform lesions are general quite distant from the fovea (as was the case with our patient). Hopefully with increasing recognition there will come answers!
Song W, Randhawa S, Johnson MW, Bohn M, Agarwal A, Rahimy E, Taubenslag KJ, Charbel Issa P, Mahroo OA, Bijon J, McDonald HR, Walter SD, Yonekawa Y, Sadda S, Freund KB, Sarraf D. Multifocal Vitelliform Paravascular Retinopathy (MVPR): A New Disorder in the Vitelliform Spectrum. Am J Ophthalmol. 2025 Jan;269:362-372. doi: 10.1016/j.ajo.2024.08.028. Epub 2024 Sep 4. PMID: 39237051.
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