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Duong R, Abou-Samra A, Bogaard JD, Shildkrot Y. Asteroid Hyalosis: An Update on Prevalence, Risk Factors, Emerging Clinical Impact and Management Strategies. Clin Ophthalmol 2023; 17:1739-1754. [PMID: 37361691 PMCID: PMC10290459 DOI: 10.2147/opth.s389111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
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.
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Affiliation(s)
- Ryan Duong
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Abdullah Abou-Samra
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Joseph D Bogaard
- Department of Ophthalmology, University of Virginia, Charlottesville, VA, USA
| | - Yevgeniy Shildkrot
- RetinaCare of Virginia, Augusta Eye Associates PLC, Fishersville, VA, USA
- Virginia Commonwealth University, Richmond, VA, USA
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Abstract
Purpose: Acute vision loss may accompany complete or partial posterior vitreous separation in asteroid hyalosis (AH), and pars plana vitrectomy may resolve these symptoms. Methods: Six individuals with AH and acute vision loss associated with diagnosed posterior vitreous separation were treated with pars plana vitrectomy, and visual acuity (VA) recovery was monitored for 3 months. Results: The study patients’ preoperative VA ranged from 20/25 to 20/2500 (mean, 20/150; logMAR, 0.88). The average decrease in VA with anterior progression of the hyaloid was logMAR 0.70. Following surgical clearance of the asteroid bodies, VA returned to baseline within 1 month following vitrectomy in 2 eyes, and within 3 months in all eyes. Final VA was 20/20 to 20/200 (mean, 20/35; logMAR, 0.24). Conclusions: Patients with AH may present with acute onset of severe vision loss in association with posterior vitreous separation. Vitrectomy may be curative and restore vision.
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Affiliation(s)
| | - Tarek Hassan
- Associated Retinal Consultants PC, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Lisa Faia
- Associated Retinal Consultants PC, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Kimberly Drenser
- Associated Retinal Consultants PC, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Bruce Garretson
- Associated Retinal Consultants PC, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
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Sato T, Koh S, Mori R, Korehisa H, Hayashi K. Impact of asteroid hyalosis on internal higher-order aberrations in eyes with cataract accompanied by acoustic shadows on swept-source optical coherence tomography examination. J Cataract Refract Surg 2020; 46:e1-4. [PMID: 32675656 DOI: 10.1097/j.jcrs.0000000000000303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Increased internal higher-order aberrations (HOAs) have been reported in eyes with asteroid hyalosis, which is usually asymptomatic. This report describes 2 patients with cataract and concurrent asteroid hyalosis. In the first case, internal HOAs were within the normal range, and swept-source optical coherence tomography (SS-OCT) did not show acoustic shadows. After cataract surgery, visual acuity improved and internal HOAs remained within normal limits. However, in the second case, SS-OCT revealed multiple acoustic shadows, presumably due to asteroid hyalosis, and internal HOAs increased in both eyes. After combined vitrectomy and cataract surgery, visual acuity and the internal HOA values improved in both eyes, and acoustic shadows disappeared on SS-OCT. Phacovitrectomy should be considered if the cause of visual impairment is cataract and asteroid hyalosis. Objective assessment of internal HOAs by a wavefront sensor and checking for acoustic shadows on SS-OCT might be useful in detecting this combination of ophthalmic conditions.
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Scott DAR, Møller-Lorentzen TB, Faber C, Wied J, Grauslund J, Subhi Y. Spotlight on Asteroid Hyalosis: A Clinical Perspective. Clin Ophthalmol 2021; 15:2537-2544. [PMID: 34168427 PMCID: PMC8217736 DOI: 10.2147/opth.s272333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/31/2021] [Indexed: 11/23/2022] Open
Abstract
Asteroid hyalosis is a benign degenerative condition of the vitreous that is often asymptomatic. Our purpose with this narrative review is to provide a current overview of asteroid hyalosis from a clinical perspective. We review the epidemiology and risk factors, the clinical diagnosis and differential diagnoses, clinical challenges in eyes with asteroid hyalosis, and the treatment of asteroid hyalosis. Many clinical questions remain unanswered, and the current evidence to guide clinical practice is largely based on anecdotal evidence and clinical experience. More studies on asteroid hyalosis from a clinical perspective are warranted.
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Affiliation(s)
| | | | - Carsten Faber
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
| | - Jimmi Wied
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jakob Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark
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Lee SM, Jang JK, Ahn J. Asteroid Hyalosis that Caused Decreased Vision after Cataract Surgery. J Korean Ophthalmol Soc 2020. [DOI: 10.3341/jkos.2020.61.1.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Min Lee
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jeong Kyeong Jang
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jaemoon Ahn
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Affiliation(s)
- Shreyansh Doshi
- Vitreoretina and Uveitis Department, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Avinash Pathengay
- Vitreoretina and Uveitis Department, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Sayali Sane
- Vitreoretina and Uveitis Department, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Merlin Saldanha
- Vitreoretina and Uveitis Department, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
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Abstract
Asteroid hyalosis is a relatively common cause of vitreous opacities, which is possibly associated with diabetes mellitus and hereditary pigmentary retinopathies. We review the history, epidemiology, and biochemistry of asteroid hyalosis, as well as its relationship with ocular and systemic conditions. We describe imaging modalities used for diagnostic evaluations in cases of severe asteroid hyalosis and propose hypotheses regarding its lack of significant effects on vision. We discuss cataract surgery in patients with asteroid hyalosis and the selection of intraocular lenses for implantation.
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Affiliation(s)
- Matin Khoshnevis
- Department of Ophthalmology, Temple University, Philadelphia, Pennsylvania, USA; VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA
| | - Sasha Rosen
- VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA; Loyola University School of Medicine, Maywood, Illinois, USA
| | - J Sebag
- VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA; Doheny Eye Institute/UCLA, Los Angeles, California, USA.
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