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We illustrate the morphologic features of a 70-year-old white male with basal laminar drusen in both eyes and vitelliform detachment in the left eye (OS), visual acuity of 20/40 OS (Figure 1). The patient was imaged using a research-grade high-resolution Fourier-domain optical coherence tomography system developed at the University of California, Davis, with an axial resolution of 4.5 μm and a broadband light of 852 nm central wavelength and 78-nm bandwidth1 and a commercial Fourier-domain optical coherence tomography system (Cirrus; Zeiss Meditec, Inc, Dublin, CA).    Fig. 1  Fundus photographs and FA images of the left eye of the patient with vitelliform detachment associated with BLD. A. Color fundus photograph showing BLD seen as yellow subretinal lesions scattered over the macula and a foveal detachment. B. Red-free fundus ...    Fourier-domain optical coherence tomography B-scans showed multiple, small, nodular to sawtooth elevations of the retinal pigment epithelial/Bruch membrane (BM) layer (Figures 2 and ​and3),3), corresponding to the basal laminar drusen seen on fluorescein angiography (Figure 1, C and D).2,3 The left central macula showed a dome-shaped elevation with an intact photoreceptor inner segment–outer segment junction and thickened photoreceptor outer segment layer in the area of the detachment (Figures 2 and ​and3).3). A B-scan through the upper part of the detachment showed homogeneous hyporeflective material suggestive of subretinal fluid and the retinal pigment epithelial layer appeared irregular and elevated, suggestive of basal laminar drusen within the vitelliform detachment (Figure 3). A B-scan through the fovea showed a heterogeneous moderate-to-highly reflective subretinal material contiguous with the retinal pigment epithelial/BM layer but with a discernible separation from the overlying photoreceptor outer segment layer (Figures 2 and ​and3B).3B). The Bruch membrane appeared intact throughout the macula, although some variations in reflectivity were noted (Figures 2 and ​and3).3). A vertical B-scan through the lesion clearly demonstrates the presence of 2 distinct types of subretinal material with a sharp demarcation, the hyporeflective material filling the upper portion of vitelliform detachment and the hyperreflective material fluid filling the lower portion (Figure 3B).    Fig. 2  Averaged research-grade high-resolution FD-OCT B-scan of the fovea OS. An averaged B-scan was obtained by taking multiple B-scans (40 B-scans) over the same retinal location and coregistering and averaging the images to remove speckle noise and improve ...Fig. 3  Research-grade high-resolution and Cirrus FD-OCT B-scan images of vitelliform detachment associated with BLD. A. B-scan image obtained using research-grade FD-OCT system.1 The location of the B-scan is indicated by the white line passing through a superior ...    On Fourier-domain optical coherence tomography, the hyperreflective subretinal material appears contiguous with retinal pigment epithelium/BM, and the BM layer appeared intact within the vitelliform detachment (Figures 2 and ​and3).3). This intact BM may explain why these lesions are rarely associated with choroidal neovascularization or severe vision loss. The late hyperfluorescence seen on fluorescein angiography likely represents slow late staining of the subretinal material rather than the window defect from underlying choroidal circulation as previously speculated (Figure 1D).4 In conclusion, these high-resolution Fourier-domain optical coherence tomography images provide new morphologic insights into the pathogenesis of this rather uncommon condition.

High-Resolution Fourier-Domain Optical Coherence Tomography Findings in Vitelliform Detachment Associated with Basal Laminar Drusen