Quiz: Vitelliform Macular Lesion

A 7-year-old male born with a solitary, dysplastic kidney and considered to be in stage 4 chronic kidney disease, presented to the eye clinic with a complaint of blurred vision. Best corrected visual acuity in each eye was 20/30. Anterior and posterior segment examinations were normal except for macular lesions in both eyes (see photos). The left eye had a classic vitelliform macular lesion while the right eye showed a lesser, nondescript, yellowish foveal lesion surrounded by hyperpigmentation, just below which was a small retinal hemorrhage. Family history revealed no other known affected members and the patient has no siblings. Fundus photographs and OCT images are shown below. What could be happening?

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