Asteroid hyalosis prolapse in the anterior chamber after cataract surgery

Asteroid Hyalosis: An Update on Prevalence, Risk Factors, Emerging Clinical Impact and Management Strategies

Asteroid hyalosis (AH) is a benign clinical entity characterized by the presence of multiple refractile spherical calcium and phospholipids within the vitreous body. First described by Benson in 1894, this entity has been well documented in the clinical literature and is named due to the resemblance of asteroid bodies on clinical examination to a starry night sky. Today, a growing body of epidemiologic data estimates the global prevalence of asteroid hyalosis to be around 1%, and there is a strong established association between AH and older age. While pathophysiology remains unclear, a variety of systemic and ocular risk factors for AH have recently been suggested in the literature and may provide insight into possible mechanisms for asteroid body (AB) development. As vision is rarely affected, clinical management is focused on differentiation of asteroid hyalosis from mimicking conditions, evaluation of the underlying retina for other pathology and consideration of vitrectomy in rare cases with visual impairment. Taking into account the recent technologic advances in large-scale medical databases, improving imaging modalities, and the popularity of telemedicine, this review summarizes the growing body of literature of AH epidemiology and pathophysiology and provides updates on the clinical diagnosis and management of AH.

Asteroid Hyalosis Migration into the Anterior Chamber during Cataract Surgery

A 70-year-old male presented for cataract surgery in the right eye with pre-operative assessment significant for nuclear sclerotic cataract and asteroid hyalosis. Upon irrigation and aspiration during cataract surgery, yellow-white spheres consistent with asteroid hyalosis were visualized circulating into the anterior chamber despite an intact capsule and no apparent zonular weakness. The asteroides particles were completely aspirated by the irrigation and aspiration ports, and an intraocular lens was implanted into the capsular bag. Postoperatively, the patient did well with final visual acuity of 20/20 and no vitreous prolapse, retinal tears, or detachments noted. There are only four cases in the literature of asteroid hyalosis migrating in the anterior chamber; none of these cases are associated with migration during intraocular surgery. We hypothesize that the asteroid hyalosis migrated anteriorly and around the zonules due to the synuretic nature of the vitreous and microscopic gaps in the zonular fibers. This case demonstrates the importance of the cataract surgeon to be aware of potential migration of asteroid hyalosis into the anterior chamber during surgery.