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Clinical Image
Acute vision loss related to asteroid hyalosis
1 Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA
Address correspondence to:
Tomas Andersen
MD, MPH, Scheie Eye Institute at the University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA 19104,
USA
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Article ID: 100033Z17TA2022
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Andersen T, Miller CG, Kim BJ. Acute vision loss related to asteroid hyalosis. J Case Rep Images Opthalmol 2022;5(2):21–23.ABSTRACT
No Abstract
Keywords: Asteroid hyalosis, Pars plana vitrectomy, Posterior vitreous detachment, Vitreoretinal interface
Case Report
An 82-year-old woman with age-related macular degeneration (AMD), pseudophakia, and asteroid hyalosis presented with two weeks of blurry vision and floaters of the left eye. On examination, visual acuity of the right eye was stably limited to 20/60 due to AMD. However, examination of the left eye revealed newly decreased visual acuity of 20/500 and vitreous opacities consistent with atypical and severe asteroid hyalosis (Figure 1 and Figure 2) precluding fundus assessment by ophthalmoscopy and optical coherence tomography. Ultrasound demonstrated posterior vitreous detachment (PVD) of the left eye. Pars plana vitrectomy (PPV) was pursued to better visualize suspected worsening of AMD as the presumed etiology of her symptoms and to rule out malignancy as a cause of her floaters. However, PPV excluded AMD progression as the cause of her vision declined, as she had only mild fovea-sparing atrophy. Vitreous biopsy excluded lymphoma. Improvement in post-operative visual acuity to 20/40 confirmed that PVD in asteroid hyalosis was the etiology of her symptoms, which were entirely ameliorated by vitrectomy.
Discussion
First described by Irish ophthalmologist Alfred Hugh Benson in 1894 [1], asteroid hyalosis is a degenerative disorder of the vitreous with a prevalence estimated variably to be 1% [2], 1.2% [3], and 1.96% [4]. Clinically evident as yellow-white spherical particles suspended in the vitreous humor [5], asteroid bodies are idiopathic calcium-lipid complexes that form in the collagen meshwork of the vitreous [6].
Although asteroid bodies often hamper an examiner’s view of the fundus, they are typically visually insignificant for patients, partly because they tend not to aggregate in the anterior vitreous [7]. Accordingly, vitrectomy in asteroid hyalosis has historically been uncommon unless pursued to better evaluate and manage other co-existing pathology obscured by asteroid bodies [6].
However, recently it has been described that PVD in asteroid hyalosis likely causes asteroid bodies to concentrate anteriorly obstructing the nodal point of the eye and leading to decreased vision and myodesopsias [7]. Posterior vitreous detachment in asteroid hyalosis is uncommon due to strong vitreoretinal adhesions [4],[5],[7],[8],[9], but when the posterior vitreous does separate, the resulting anterior shifting of asteroid bodies may cause vision degradation and floaters [7]. Vitrectomy in those cases has been shown to be curative [7].
Conclusion
This case further supports this feature of PVD in asteroid hyalosis, and encourages ophthalmologists to consider vitrectomy when the development of decreased vision and floaters coincides with acute detachment of the posterior vitreous in asteroid hyalosis.
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SUPPORTING INFORMATION
Author Contributions
Tomas Andersen - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Charles G. Miller - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Benjamin J. Kim - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementConsent was not obtained because the report does not contain personal information that could lead to patient identification.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Tomas Andersen et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
