retinal imaging conference ahmet ozkok md university of louisville school of medicine department of...

Retinal Imaging

Conference

Ahmet Ozkok MDUniversity of Louisville

School of MedicineDepartment of

Ophthalmology & Visual Sciences6/5/14

Subjective CC: Decreased vision OD

HPI: 71 year-old female referred to Retina clinic for decreased vision in theright eye. She complains of difficulty driving and floaters of last few yearsduration 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 OD

OS

BCVA 20/80 20/30

-2.00 , +1.00 X 180 -0.50

Pupils: 3 → 2 3 → 2

no APDIOP: 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= 0.2Blurry view 2/2 AHVessels: atherosclerotic changes

A/V 1/2 Macula: Blurry

OS:ON: C/D=0.1Macula: blurry viewVeins: Atheroscloric changes A/V

1/2

OD

ASSESSMENT

71 year old female with epiretinal membrane and asteroid hyalosis

Plan: PPV+ERMp OD

ASSESSMENT

POW# 3BCVA 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 HyalosisRisk Factors

Age

AJO 2001;132:70-75

Asteroid HyalosisRisk Factors (under

debate) Gender (m>f) DM Hypercholesterol

emia HT Hypercalcemia

Hyperphosphatemia

Hyperopia Gout Alcohol

consumption RP

Cataract SurgeonBe Careful!

IOL calculation Falsely short axial lenght

measurement with automated biometry

Association between asteroid hyalosis and late postoperative dystrophic calcification of silicone lenses.

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.

References

Thank you