Idiopathic macular hole with asteroid hyalosis

Abstract

Introduction:Asteroid hyalosis (AH) is characterized by mild vitreous-body liquefaction and a reduced likelihood of posterior vitreous detachment (PVD). Here, we report the clinical features of 2 cases of macular hole (MH) in eyes with AH. The extent of retinal vitreous adhesion at the time of vitreous surgery, the presence or absence of iatrogenic retinal breaks, and the postoperative course was examined in regard to the association with AH.Case presentation:Case 1 involved a 67-year-old female with decreased visual acuity in her left eye. Although preoperative optical coherence tomography examination revealed complete PVD with operculum around the fovea central region, vitreoretinal adhesion was quite strong starting at the midperiphery of the fundus, and an iatrogenic retinal break was formed at the inferior site during vitreous surgery. Endophotocoagulation was performed, and no onset of retinal detachment (RD) postsurgery was observed. Case 2 involved a 74-year-old male with metamorphopsia in his right eye. Preoperative perifoveal PVD was observed, yet vitreoretinal adhesion was strong starting at the midperiphery of the fundus and multiple iatrogenic retinal breaks had formed on the inferior, superior, and temporal sites. Moreover, RD occurred during surgery. Endophotocoagulation and gas tamponade was performed; however, postoperative RD requiring multiple reoperations occurred.Conclusion:As with normal MH, MH with AH is thought to be caused by perifoveal PVD, yet as the vitreoretinal adhesion was found to be quite strong starting at the midperiphery of the fundus, we decided to keep the artificial PVD within a range where adhesion was loose.

Full-thickness macular hole repair with associated asteroid hyalosis

“…However, both cases had relatively loose and easy to peel adhesions around the macular hole, allowing for successful closure of the fullthickness macular hole. 5 More recently, Rahman et al discussed the complexities of macular hole repair in a patient with adhesions from proliferative diabetic retinopathy and hyaloid attachments from asteroid hyalosis. Similar to the other reports, the area of hyaloid around the macular hole was able to be released from the adhesions with ease, leading to successful macular hole repair.…”

Limbal Approach Phacovitrectomy to Treat Cataract with Clinically Significant Asteroid Hyalosis—Presentation of the Technique and Preliminary Results

“…Kitagaki et al [ 9 ] presented two cases of idiopathic macular hole with AH. They performed standard phacovitrectomy and observed very strong vitreoretinal adhesion starting at the mid-periphery, resulting in multiple iatrogenic tears during surgery.…”

“…These adhesions probably enhance with coexisting maculopathy or proliferative diabetic retinopathy. It has been reported that there is an increase in inflammation-related cells, such as macrophages, in the vitreous of AH and that prolonged mild inflammation might accelerate the manifestation of the adhesion molecules at the vitreoretinal interface [9]. Kitagaki et al [9] presented two cases of idiopathic macular hole with AH.…”

“…It has been reported that there is an increase in inflammation-related cells, such as macrophages, in the vitreous of AH and that prolonged mild inflammation might accelerate the manifestation of the adhesion molecules at the vitreoretinal interface [9]. Kitagaki et al [9] presented two cases of idiopathic macular hole with AH. They performed standard phacovitrectomy and observed very strong vitreoretinal adhesion starting at the mid-periphery, resulting in multiple iatrogenic tears during surgery.…”