金台診所醫學美容的部落格

By Prof Dr.Gehad Elnahri

Yellow Fundus Lesions

Many times we see the yellow color in the fundus
This color is never in a normal fundus except in one subtle situation (which?)
The best way to diagnose a yellow fundus lesion is to identify its pathologic nature
So what are these?
1)lipid: this is the most common; it may be superficial or deep; rarely intravascular (lipemia)
2)drusen and drusen-like lesions; also common
3)yellow masses; granulomas and tumors; generally rare



*Lipid in the retina
-source: leak from incompetent retinal vessels with broken blood-retinal barrier, it does not come from choroidal vessels; the leak is vasculopathic or inflammatory.
-if the leak is from the superficial retinal plexus it gravitates with the edema fluid, being heavier, into the plexiform layers. Leaks around the macula tend to arrange along Henle fiber layer forming a "fan". It is usually "discrete" and generally may look like drusen (fig 1,2,3,4). It may be in all quadrants in retinopathies or one quadrant in venous occlusions, aneyrysms and leaky tumors. It tends to form circinate rings.
-subretinal lipid comes from the deep plexus or extensive leaks from the superficial plexus in Coat's disease or retinal angiomas. It is generally diffuse and may simulate granulomas and tumors esp. if under exudative retinal detachment (fig 5,6,7)



*Drusen and drusen-like lesions
These are present in or under the RPE. They are lipid-containing proteinaceous material with tendency to Calcium deposition.
These are the most diverse to diagnose but generally fall into 2 categories
-Age related drusen; hard or soft (fig 8,9,10)
-degenerations generally called retinal flecks (fig 11,12) diagnosis depends on characteristic shapes and manifestations



*yellow masses include
-tumors; superficial esp astrocytic hamartomas (fig 13,14) and combined hamartoma (15) and deep esp. choroidal osteoma (fig 16), lymphomas (fig 17) and secondaries (fig 18)
-Granulomas; esp infectious as TB and PORN, or non infectious as PIC and geographic choroidopathy (19,20)
-vitelliform masses (fig 21,22)
-subretinal lipid may simulate masses, if it occurs in disease other than Coat's disease, it is called Coat's response. (Fig 23,24)



By Dr.Ihab OthmanRadiation retinopathy comes 2-3 years following either teletherapy or brachytherapy. This si due to the low replication rate of the retinal neural structure. The same goes to the optic nerve. It is either proliferative (with neovessels) or non proliferative. It usually comes with attenuated atretic vessels (not dilated or congested), RPE changes and a dry fundus. The presence of this gray nodule in the macula is more with CNV coming with chronic RPE irritation and SRF. The absence of a pale optic nerve is also not going with radiation retinopathy.
One should look at the periphery in cases of similar macular exudates for retinal hemangioblastoma of VHL and retinal tangiectasia of Coats.