Temporary Vitelliform Regression After Intravitreal Ranibizumab Injection for Macular Neovascularization Complicating Best Disease

BACKGROUND: In this report, we present a case of a 12-year-old boy with Best vitelliform macular dystrophy (BVMD) complicated by macular neovascularization (MNV) and treated with two intravitreal ranibizumab injections. We document an unusual temporary regression of his vitelliform deposits and describe a 2-year follow-up course through multimodal imaging. CASE PRESENTATION: A 12-year-old boy complaining of metamorphopsia presented with bilateral yellowish subfoveal deposits, suggestive of BVMD, which was confirmed by fundus autofluorescence and electrooculography. The left eye showed an inferior juxtafoveal complicating MNV, for which the patient was treated with two intravitreal ranibizumab injections. In addition to demonstrating a remarkable response to injection, both clinically and through various multimodal imaging modalities, optical coherence tomography (OCT) showed a surprising temporary resolution of the subfoveal hypopreflective space denoting a regression in the lipofuscin deposits accumulating at the RPE and the subfoveal space. Within 2 months, there was a subsequent build-up of the subfoveal space and lipofuscin reaccumulation through serial imaging despite the clear regression of the MNV. The patient remained stable over a course of 2 years. CONCLUSION: Our findings cast light on a rather unusual response to intravitreal anti-VEGF injections that has not been previously reported in literature in the form of a temporary disappearance of the subfoveal vitelliform deposits, which later began to reaccumulate. This process may reflect a temporary relief of the RPE dysfunction or decreased photoreceptor damage with regression of the complicating MNV, leading to decreased vitelliform deposition. Adding to other reports, our findings also provide a 2-year-long follow-up with serial multimodal documentation of the response to injection and suggest a favorable long-term prognosis for intravitreal anti-VEGF injections in eyes with BVMD presenting with early complicating MNVs.