Transcript Document

Retinal Imaging
Conference
Ahmet Ozkok MD
University of Louisville School
of Medicine
Department of Ophthalmology
& Visual Sciences
6/5/14
Subjective

CC: Decreased vision OD

HPI: 71 year-old female referred to Retina clinic for decreased vision in the
right eye. She complains of difficulty driving and floaters of last few years
duration and getting worse gradually.

POH: CE+IOL OU 2004

PMHx: NIDDM (10 years), artritis, hypothroidism, GERD

Meds: Omeprozole, hydrocodone, metformin, levothyroxine, meloxicam

Allergies: Codeine
Exam
BCVA
OD
OS
20/80
20/30
-2.00 , +1.00 X 180
Pupils:
-0.50
3→2
3→2
no APD
IOP:
11 mm Hg
12 mm Hg
EOM:
Full OU
CVF:
Full OU
Ant Segment: PCIOL OU
Slit lamp photo
OD
OS
Exam
DFE:OD:
ON: C/D= 0.2
Blurry view 2/2 AH
Vessels: atherosclerotic changes A/V 1/2
Macula: Blurry
OS:
ON: C/D=0.1
Macula: blurry view
Veins: Atheroscloric changes A/V 1/2
OD
ASSESSMENT


71 year old female with epiretinal membrane and
asteroid hyalosis
Plan: PPV+ERMp OD
ASSESSMENT
POW# 3
BCVA 20/60+
Take Home Message
Fa and oct
Asteroid Hyalosis
 Characterized by diffuse spherical white
opacities stuck to vitreous
 Unilateral (75-90% )
 Etiology ?
 Calcium-associated phospholipids
 Presence is obvious upon ocular exam but
patients are usually asymtomatic
 May interfere with retina exam (FA, OCT, AF)
 Rarely cause visual disturbance and needs Sx
Asteroid Hyalosis
Risk Factors
 Age
AJO 2001;132:70-75
Asteroid Hyalosis
Risk Factors (under debate)
 Gender (m>f)
 Hyperphosphatemia
 DM
 Hyperopia
 Hypercholesterolemia
 Gout
 HT
 Alcohol consumption
 Hypercalcemia
 RP
Cataract Surgeon
Be Careful!
IOL calculation
 Falsely short axial lenght measurement with
automated biometry
Association between asteroid hyalosis
and late postoperative dystrophic
calcification of silicone lenses.
References
1.
Ikeda Y, Hisatomi T, Murakami Y, Miyazaki M, Kohno R, Takahashi H, Hata Y, Ishibashi T: Retinitis pigmentosa associated
with asteroid hyalosis. Retina 2010, 30(8):1278-1281.
2.
Kador PF, Wyman M: Asteroid hyalosis: pathogenesis and prospects for prevention. Eye 2008, 22(10):1278-1285.
3.
Fawzi AA, Vo B, Kriwanek R, Ramkumar HL, Cha C, Carts A, Heckenlively JR, Foos RY, Glasgow BJ: Asteroid hyalosis in an
autopsy population: The University of California at Los Angeles (UCLA) experience. Archives of ophthalmology 2005,
123(4):486-490.
4.
Browning DJ, Fraser CM: Optical coherence tomography to detect macular edema in the presence of asteroid hyalosis.
American journal of ophthalmology 2004, 137(5):959-961.
5.
Foot L, Werner L, Gills JP, Shoemaker DW, Phillips PS, Mamalis N, Olson RJ, Apple DJ: Surface calcification of silicone plate
intraocular lenses in patients with asteroid hyalosis. American journal of ophthalmology 2004, 137(6):979-987.
6.
Mitchell P, Wang MY, Wang JJ: Asteroid hyalosis in an older population: the Blue Mountains Eye Study. Ophthalmic
epidemiology 2003, 10(5):331-335.
7.
Komatsu H, Kamura Y, Ishi K, Kashima Y: Fine structure and morphogenesis of asteroid hyalosis. Medical electron microscopy :
official journal of the Clinical Electron Microscopy Society of Japan 2003, 36(2):112-119.
8.
Moss SE, Klein R, Klein BE: Asteroid hyalosis in a population: the Beaver Dam eye study. American journal of ophthalmology
2001, 132(1):70-75.
9.
Winkler J, Lunsdorf H: Ultrastructure and composition of asteroid bodies. Investigative ophthalmology & visual science 2001,
42(5):902-907.
Thank you