Pathological Findings of Synchysis Scintillans Secondary to Familial Exudative Vitreoretinopathy With Chronic Exudative Retinal Detachment

Abstract

Purpose: We describe a unique case of synchysis scintillans in a 23-year-old woman with a history of chronic exudative retinal detachment in the setting of familial exudative vitreoretinopathy. Methods: Fundus and slit-lamp photographs were obtained at presentation, and pathological studies were performed on the enucleated specimen to confirm the diagnosis. Results: Synchysis scintillans is a degenerative condition of cholesterol deposition that affects severely damaged eyes, often as a result of chronic vitreous hemorrhage or retinal detachment. In this case, synchysis scintillans presented as crystals in the anterior chamber in the setting of a chronic retinal detachment. After enucleation, there were noted to be cholesterol slits on pathological correlation, confirming the diagnosis. Conclusions: This case demonstrates the importance of clinical pathological correlation in the diagnosis of synchysis scintillans migrating into the anterior chamber.

Haemoglobin spherulosis: Fine needle aspiration biopsy of an unusual ocular lesion

“…In addition, due to the presence of acid mucopolysaccharides, the spherical bodies of AH stain with both colloidal iron and Alcian blue stains. 8 Cytological specimens from cholesterosis bulbi (synchisis scintillans) show highly refractile cholesterol crystals, 9 whereas vitreous cylinders are structures composed of loose collagen fibres and spindle cells that resemble glial cells or fibroblasts unlike the glassy beads of HS. 10 The reason for the tendency of free haemoglobin in the vitreous to form spherules is not entirely known.…”

A novel terminologic “naming-meshing” system using anterior chamber sedimentation for early diagnosis and prompt treatment of ocular or systemic diseases: is it hypopyon or pseudohypopyon?

“…The usual form of sediment [1,3,[4][5][6][7][8][9][10] Warm (pseudo)hypopyon An acute type of perilimbal vascular injection with deep and superficial vessel dilations (a bloodshot eye) in the presence of severe anterior segment inflammation OBD, HLA-B27-related AAU, pseudohypopyon from retinoblastoma Cold (pseudo)hypopyon Lack of periglobal injection despite the presence of severe intraocular inflammation (an uninjected white eye in a hot disease) OBD, after IVTA injection (may be called cold pseudohypopyon), tumoral sediment, subacute neuroretinitis 9. Laterality-Alternation-Symmetry [1,[4][5][6] Unilateral hypopyon In about one-third of cases in the same eye at a given time Height (select regularly one) [1,[4][5][6][8][9] Millimeter (mm) e.g., 3 mm in height or 3 mm hypopyon The usual form that is important for the follow-up Proportion e.g., one-third of the anterior chamber May be used Percentage (%) e.g., occupying 30% of the anterior chamber May be used 11.…”

“…Primary or metastatic intraocular neoplasms 13. Sterility [1,[3][4][5][6][8][9][10][11][12][13][14][44][45] Sterile hypopyon Non-infective inflammatory sediment that does not contain any microorganism OBD, HLA-B27-related AAU, recurrent corneal erosions…”

“…Obviously, if such neoplastic anterior chamber sediments are visible to the naked eye in a white eye, "a cold tumoral macro-pseudohypopyon" would be preferred to fully express the descriptive characteristics of the collection. Apart from tumoral sediment formation itself, a "non-tumoral pseudohypopyon" consisting of cholesterol crystals in the anterior chamber may be observed in eyes with advanced cases of cholesterolosis bulbi with or without subretinal crystals upon vitreous hemorrhage after severe trauma, long-standing retinal detachment, and retinoblastoma [10] . Sterility of Sediment "Sterile hypopyon" is defined when the sediment contains no microbial organism.…”