Visual Outcomes of Pars Plana Vitrectomy with Epiretinal Membrane Peeling in Patients with Asteroid Hyalosis: A Matched Cohort Study

Abstract

Background: The study aimed to evaluate outcomes of epiretinal membrane (ERM) peeling in patients with asteroid hyalosis (AH) and to compare them with those from controls without AH. Methods: This is a retrospective matched cohort study of 1,104 consecutive patients who underwent surgery for ERM between January 2004 and February 2014. Patients with AH were included in the study group and were matched for preoperative visual acuity, age, gender, date of surgery, and axial length with control patients without AH selected from the same cohort. The best-corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography were measured at baseline and postoperatively with a minimum follow-up period of 12 months. Results: A total of 44 patients were included in the AH group and 44 in the control group. The mean initial BCVA was 0.53 ± 0.21 LogMAR for the AH group vs. 0.49 ± 0.20 LogMAR for the control group, and the mean initial CMT was 419 ± 74 vs. 423 ± 75 µm, respectively. During the follow-up, no significant difference was found regarding the final BCVA at 6 months (0.23 ± 0.14 vs. 0.24 ± 0.17) LogMAR (p = 0.87) and 12 months (0.16 ± 0.09 vs. 0.17 ± 0.12) LogMAR (p = 0.92), despite a tendency toward slower visual recovery for the AH group at 1 month, with a mean BCVA of 0.36 ± 0.12 vs. 0.28 ± 0.18 LogMAR (p = 0.08). No difference was found regarding the progression of CMT at 1.6 and 12 months with a mean CMT of 396 ± 47 vs. 378 ± 55 µm (p = 0.39), 356 ± 39 vs. 365 ± 41 µm (p = 0.48), and 349 ± 68 vs. 352 ± 53 µm (p = 0.87), respectively. Conclusion: Vitrectomy with ERM peeling in patients with AH was beneficial and showed similar functional and anatomical outcomes in both groups. AH does not seem to affect visual improvement or the complication rate after ERM peeling. Therefore, the indications for vitrectomy in case of ERM should not be prompted by the presence of AH.

Idiopathic macular hole with asteroid hyalosis

“…As to the macular diseases that can accompany AH, numerous studies have reported macular edema and epiretinal membrane, etc. [ 7 – 10 ] Although many of those macular diseases are reported to have often been caused by the primary disease, such as diabetic retinopathy, the study by Hwang et al [ 9 ] is the only previous report related to AH accompanied by MH. As in this present study, they reported a case of a stage 3 MH in which partial PVD had occurred in the posterior pole and in which partial PVD had also occurred in the optic disc head site.…”

“…In that study, Benson [ 1 ] pointed out that the vitreous liquefaction was slight and that it was difficult for posterior vitreous detachment (PVD) to occur as a characteristic of eyes with AH, [ 2 – 6 ] as well as that it may complicate epiretinal membrane and macular edema. [ 7 – 10 ] To the best of our knowledge, there has only been 1 previous report indicating the occurrence of a macular hole (MH) in eyes with AH. [ 9 ] Here, we report the clinical features of 2 cases with AH that underwent vitreous surgery for an MH.…”

Spotlight on Asteroid Hyalosis: A Clinical Perspective

“… 38 In a study of patients who underwent vitrectomy with peeling for epiretinal membrane, Mouna et al showed that patients with epiretinal membrane with or without asteroid hyalosis had similar anatomical and functional outcomes, including the best-corrected visual acuity. 38 Thus, prognosis is often good without treatment, but the rare cases with increasingly dense asteroid hyalosis may eventually impact vision and in these cases a vitrectomy may be of benefit to the patient. Of note, vitrectomy in AH is often challenging due to vitreoschisis and abnormal vitreoretinal adhesion increasing the risk of complications.…”

“…However, since asteroid hyalosis rarely causes symptoms, asteroid hyalosis by itself is rarely the actual indication of treatment. 38 In a study of patients who underwent vitrectomy with peeling for epiretinal membrane, Mouna et al showed that patients Examination of anterior vitreous reveals cells that are in a white hue. Some cases are also accompanied by cells and flare in the anterior chamber.…”

Full-thickness macular hole repair with associated asteroid hyalosis

“…The presence of asteroid hyalosis has been infrequently associated with causing complications, including calcified intraocular silicone lenses 1 and rhegmatogenous retinal detachments. 2 Abnormalities of the vitreoretinal surface in the setting of asteroid hyalosis do not necessarily dictate a negative vitrectomy prognosis 3 but can occasionally cause complications. We present a case illustrating enlargement of a full-thickness macular hole during surgical repair in a patient with very strong vitreoretinal adhesions around the macular hole and asteroid hyalosis.…”