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VITREOUS DISEASES

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Asteroid Hyalosis  
 

Asteroid hyalosis (Benson’s disease) is a benign condition characterized by multiple-yellow-white, round, birefringent particles composed mainly of calcium-phosphate attached to...

Asteroid hyalosis (Benson’s disease) is a benign condition characterized by multiple-yellow-white, round, birefringent particles composed mainly of calcium-phosphate attached to the vitreous.

The incidence has been estimated to be 0.5%.

The cause of asteroid hyalosis is unknown, but it has been associated with hyperopia, diabetes mellitus, hypertension and hypercholesterolemia.

Clinically the asteroid bodies remain attached to the vitreous’ collagenous framework, moving only when this network oscillates. They appear golden under retroillumination and white under direct illumination. This pathology is usually unilateral (75%) and found in elderly patients over 60 years of age.

Retinography is sometimes difficult in these patients due to the numerous flash reflections originating from the hyaloid bodies. Fluorescein angiography allows a better visualization of the retina in difficult cases.

In ultrasonography these vitreous bodies appear as hypereflective deposits in the vitreous cavity and may increase the difficulty of obtaining a reliable axial length measurement.

Asteroid hyalosis rarely affects the patient's visual acuity, even in cases of severe vitreous involvement. In these cases vitrectomy is indicated.

Differential Diagnosis

  • Amyloidosis
  • Cholesterolosis

References

Basic and Clinical Science Course – 2011-2012 – Section 12 – Retina and Vitreous, American Academy of Opthalmology

Bergren RL, Brown Ge. Duker JS. Prevalence and association of asteroid hyalosis with systemic diseases. Am J Ophthalmol. 1991;111 :289- 293

Fawzi AA, Vo B, Kriwanek R, Ramkumar HL, et al, Asteroid hyalosis in an autopsy population: The University of California at Los Angeles (UCLA) experience. Arch Ophthalmol. 2005 Apr;123(4):486-90

Paramyloidosis  
 

Amyloidosis is a term that refers to a variety of disorders, characterized by the deposition of amyloid proteins in several...

Amyloidosis is a term that refers to a variety of disorders, characterized by the deposition of amyloid proteins in several organs and tissues.

Amyloids are fibrillar insoluble protein condensates that acquire a terciary conformation, known as beta-pleated sheat.

Patients with amyloidosis can be divided into three groups: primary familial amyloidosis (PFA), familial amyloidotic polyneuropathy (FAP) and secondary amyloidosis. Only PFA and FAP are associated with vitreous deposits.

In PFA, portions of immunoglobulin light chains form tissue deposits (AL amyloid). FAP is related to mutations in the protein transthyretin (most commonly at locus 18q11.2-q12.1), inherited in an autosomal dominant fashion.

Systemic clinical features include renal dysfunction, cardiomyopathy and peripheral neuropathy.

Ophthalmological features include ecchymosis of lids, proptosis, ocular palsies, internal ophthalmoplegia and neuroparalytic keratitis. Glaucoma may be caused by amyloid deposition in the aqueous outflow areas. In the posterior segment, several features such as granular glass-wool opacities that form in the vitreous cortex, strands attached to the retina, granular deposits along the retinal vessels, retinal vascular occlusions, cotton-wool spots, retinal neovascularization, and compressive optic neuropathy can be observed.

Symptoms of vitreous involvement include floaters, decreased vision and sometimes diplopia.

Differential Diagnosis:

  • Asteroid hyalosis
  • Old vitreous hemorrhage
  • Vitritis

References

Basic and Clinical Science Course – 2011-2012 – Section 12 – Retina and Vitreous, American Academy of Opthalmology

Basic and Clinical Science Course – 2011-2012 – Section 4 – Ophthalmic Pathology and Intraocular Tumors, American Academy of Opthalmology

Ola Sandgren, Ocular Amyloidosis, with Special Reference to the Hereditary Forms with Vitreous Involvement, Surv Ophthalmol 40 (3) November-December 1995