Refractile superficial retinal crystals and chronic retinal detachment: Case report

Abstract

BackgroundFew previous reports have described the presence of retinal refractile opacities at the macular area in patients presenting with longstanding peripheral retinal detachment. The exact nature of these opacities is unknown.Case presentationTwo patients were referred with an abnormal appearance of refractile opacities in the macular area noted during routine examination. Both were found to have longstanding peripheral retinal detachments. Subretinal fluid analysis of one patient revealed the presence of multiple birefringent crystals. We hypothesise that these crystals are the origin of the refractile macular opacities noted.ConclusionThis report describes the rare presentation of asymptomatic peripheral retinal detachment by the detection of refractile macular opacities on routine examination. It highlights the importance of meticulous peripheral retinal examination in these cases. The article also describes the findings of the subretinal fluid analysis and discusses the possible hypothesis behind their appearance.

Crystalline Maculopathy Secondary to Retinal Tear Without Detachment

“…Kovach et al speculated that hemosiderin-laden macrophages and erythrocyte-breakdown products cause crystal deposition in chronic RD. 1,3 Other studies have suggested that on retinal damage, photoreceptor outer segment particles become released in the vitreous and subsequently deposit on the surface of the posterior hyaloid or the internal limiting membrane as crystals. [2][3][4][5] It is possible that macrophage ingestion of these photoreceptor outer segment particles leads to formation of oxalate crystals that are then released into the vitreous through the retinal break.…”

“…1,3 Other studies have suggested that on retinal damage, photoreceptor outer segment particles become released in the vitreous and subsequently deposit on the surface of the posterior hyaloid or the internal limiting membrane as crystals. [2][3][4][5] It is possible that macrophage ingestion of these photoreceptor outer segment particles leads to formation of oxalate crystals that are then released into the vitreous through the retinal break. In the absence of a posterior vitreous detachment, the crystals may then migrate to the premacular bursa and deposit at the interface between the posterior hyaloid and the internal limiting membrane of the retina.…”

Optical Coherence Tomographic Findings in Bietti’s Crystalline Tapetoretinal Dystrophy

“…Although we did not observe a certain OCT feature of the intraretinal crystals, some hyperreflective pointlike lesions seen within the neurosensory retina and some irregularities appreciated on the hyperreflective band could be related to crystals. The OCT performed in other diseases characterized by intraretinal crystals like cathaxanthine retinopathy 5 and chronic retinal detachment 6 show that crystals are seen as small hyperreflective lesions and not as a diffuse hyperreflectivity. Some of the inconsistent findings found in the Meyer et al 4 report compared to ours could be explained by the different stage of the disease observed in the separate studies, since the greater number of crystals present in the early case described by Meyer et al 4 could produce an extensive backscattering.…”

Crystalline retinopathy associated with chronic macular hole; a report of two cases

“…Sir, Crystalline retinopathy associated with chronic macular hole; a report of two cases Crystalline retinopathy has been associated with a variety of toxic, metabolic hereditary conditions, chronic retinal detachment (RD), and retinal dialysis. [1][2][3][4] The origin of the crystalline opacities in patients with RD has been speculative and controversial. 1,3,4 We describe two cases of crystalline retinopathy in patients with no history of systemic illness or drug use, with chronic full thickness macular holes (FTMHs).…”

“…[1][2][3][4] The origin of the crystalline opacities in patients with RD has been speculative and controversial. 1,3,4 We describe two cases of crystalline retinopathy in patients with no history of systemic illness or drug use, with chronic full thickness macular holes (FTMHs).…”