Scleral Plaques Research Articles

Senile scleral plaque – Clinical and anterior segment optical coherence tomography correlation

Senile scleral plaques are common age-related degenerative changes quite often diagnosed on routine examination. We report a case of an elderly female, incidentally noted to have clinical findings suggestive of a senile scleral plaque. Anterior segment optical coherence tomography (AS-OCT) concurred with clinical findings. They are in general non-progressive or slowly progressive. Although the risk of progression is rare, considering the rare possibility of perforation, we recommend periodic review both clinically and with AS-OCT. Imaging may also be valuable in patients with senile scleral plaques undergoing scleral procedures and repeated intravitreal injections to understand the possible risks of perforation.

Capabilities of optical coherence tomography in examination of senile scleral plaques

To assess the morphological characteristics of SSP using spectral optical coherence tomography (OCT). The study examined 13 patients (21 eyes) with average age of 77.1±6.3 years. OCT scanning was performed to determine OCT signs of SSP, the length (parallel to the limb), the width and height of the SSP, as well as the depth and thickness of the overlying sclera. A combination of nasal and temporal SSP was observed in 14 eyes, and nasal only SSP was detected in 6 eyes. In all cases, OCT presented a characteristic picture of SSP observed as an intrascleral cavity with hyperreflective content with lower reflectivity than the surrounding tissues, and clear borders represented by unchanged scleral fibers. The length of the SSP parallel to the limb was 3296±820 µm, the width - 2312±436 µm, the height of the SSP cavity - 482±89 µm. The depth of SSP site was 213±36 µm, the thickness of the overlying sclera - 125±29 µm. Updated information about SSP structure can be used in the development of standard surgical algorithms contributing to prevention of postoperative complications.

Physiological characterization of ocular melanosis-affected canine melanocytes.

Cairn terriers with ocular melanosis (OM) accumulate large, heavily pigmented melanocytes in the anterior uvea. Darkly pigmented plaques develop within the sclera, leading us to hypothesize that OM uveal melanocytes may have an abnormal migratory capacity. Globes from OM-affected Cairn terriers and unaffected control eyes enucleated for reasons unrelated to this study were used for immunohistochemistry and to culture melanocytes for invitro cell behavior assays. The scleral plaques of six dogs were immunolabeled for HMB-45, MelanA, PNL2, CD18, CD204, and Iba-1 and compared with the pigment cells accumulated within the irides. Cultured uveal melanocytes from OM-affected and control dogs were compared using conventional assays measuring cell proliferation, invasion capability, and melanin production. Melanocytes isolated from OM eyes had significantly elevated levels of per-cell melanin content and production compared to controls. The majority of pigmented cells in the scleral plaques were HMB45 positive indicating a melanocytic origin. Many were also CD18 positive. No differences were observed between cultured melanocytes from OM-affected and control uvea for standard invitro proliferation or invasion assays. Pigmented cells which accumulate in the sclera of OM-affected Cairn terriers are predominantly melanocytes; however, invitro assays of uveal melanocytes did not reveal differences in migratory behavior between OM and control cells. Migratory behavior of OM-melanocytes may be environment-dependent. We suggest that RNA sequencing and differential expression analysis would be a useful next step in understanding this disease.

Senile scleral plaques

Nous rapportons le cas d'une femme âgee de 75 ans, hypertendue sous traitement, pseudophake au niveau de l'œil droit, cataracte de l'œil gauche et chez qui l'examen ophtalmologique decele de facon bilaterale et symetrique des zones de depression sclerale de couleur grisâtre situee en avant de l'insertion des deux muscles droits internes. La plaque sclerale est le resultat d'une degenerescence de la sclere liee a l'âge et est habituellement asymptomatique. La zone sclerale touchee devient mince et legerement deprimee. Les lesions sont decrites comme etant bilaterales, symetriques, bien definies et de forme ovoide. Elles sont habituellement situees en avant de l'insertion des muscles droits internes.

This issue of ACTA, printed and electronic

The cover illustration shows senile scleral plaques which is reported by Beck et al. in the electronic part of this issue of ACTA. Grzybowski points out that the various disciplines in medicine and science differ in size and that this effects the impact factor calculation. Scheerlinck et al. in the Netherlands found that the preoperative vision predicts postoperative visual acuity in many studies on epiretinal membrane surgery. OCT characteristics, metamorphopsia and autofluorescence may also have a prognostic role. Fernandes et al. in the United Kingdom and China reviewed smoking during pregnancy and vision difficulties in children. There were higher rates of strabismus, refractive errors and retinopathy among children of women who smoked during pregnancy. Leivo et al. in Helsinki describe a considerable risk of eye injury in sports, such as ice hockey and tennis. Klefter et al. in Denmark used motion-contrast velocimetry to study the regulation of retinal perfusion. Faber et al. in Denmark found increased plasma levels of tumour necrosis factor to be associated with age-related macular degeneration. They suggest that this supports low-grade inflammation. Knaapi et al. in Finland refine an old method to determine the actual size of retinal features on a fundus photograph. Carreno et al. in the United Kingdom, Australia and Spain describe panuveitis with nodular peripapillary changes in juvenile systemic granulomatous disease also known as Blau syndrome. Fledelius et al. in Copenhagen describe corneal deposits and abnormal vessel morphology in patients with Fabry disease. Holmström et al. in Sweden evaluated new Swedish guidelines for screening for retinopathy of prematurity and found the guidelines adequate. Zetterberg et al. in Sweden used anterior chamber angle surgery and in some cases tube implantation to treat paediatric glaucoma. Pärssinen et al. in Finland studied the prevalence of and changes in astigmatism from the onset of myopia at school age. They found that the prevalence and mean amount of refractive astigmatism associated with corneal astigmatism increased, and the axis of astigmatism changed among myopics during the 23-year follow-up. Koefoed et al. in Norway found that contrast sensitivity is not diminished by sleep deprivation. Talebizadeh et al. Uppsala describe the distribution of caspase-3 in the rat lens and suggest this enzyme may be involved in cataract formation. Mollazadegan and Lundström in Sweden analysed the relationship between patient-reported outcome measures and clinical outcome measures in 42 individual Swedish cataract surgery settings. For some clinics, up to 50% of the patients stated that they were very satisfied with their vision before surgery. The following articles are published electronically only. They are available on www.actaophthalmologica.com. On actaopthalmologica.com, you can find all the articles of this issue of ACTA and indeed all articles published in ACTA from the beginning. Eppig et al. in Germany found that the aberration-correcting intraocular lenses are associated with better contrast sensitivity. Beck et al. in Switzerland study senile scleral plaques with imaging and anterior segment OCT. They point out that these plaques have gained increased interest since the advent of intravitreal injections. These plaques are depicted on the cover of this issue of ACTA. Pérez-Rico et al. in Spain found the poor glucose control affects corneal biomechanics in patients with diabetes. Steinberg et al. in Germany and the United Kingdom validated a previously described algorithm as well as Scheimpflug tomography for the diagnose and classification of keratoconus. Rao et al. in India found that the spectral domain OCT imaging of the neuroretinal rim of the optic nerve did not adequately differentiate between glaucomatose and non-glaucomatose discs. Tanito et al. in Japan found no association between exfoliation and central retinal vein occlusion even when they used the LOXL1 gene as a marker for exfoliation. Maestroni et al. in Italy found that vasostatin-1 prevents choroidal neovascularization in mice. Zhang et al. in China found gene polymorphisms which are associated with increased risk of proliferative diabetic retinopathy in a Chinese population. Kessel et al. in Denmark review ocular injuries from ammonium hydroxide sprayed into eyes. Massamba et al. in France found that the pain associated with intravitreal injection was greater in the inferior quadrants of the eye and in the right eye. Rantala and Majander in Helsinki used OCT to image cornea plana. Iribarren et al. in Norway describe the loss of refractive power of the lens in early adulthood. Fleischman et al. in USA reviewed cerebrospinal fluid pressure trends in diseases associated with glaucoma. Sung et al. in Korea found OCT reliable in assessing nerve fibre layer thickness regardless of refractive error. Tanito et al. in Japan describe a bidirectional flow of aqueous following glaucoma tube surgery. Introini et al. in Italy describe ischaemic maculopathy associated with cocaine use. I hope that the current issue of ACTA provides pleasant and educational reading in your summer house and elsewhere.

Senile scleral plaques imaged with enhanced depth optical coherence tomography.

Senile scleral plaques (SSP) are sharply demarcated greyish areas located just anterior to the insertions of the horizontal rectus muscles and thus are frequently encountered during transscleral intravitreal injections. The aim of this study was to characterize SSP using enhanced depth imaging spectral domain anterior segment optical coherence tomography (OCT) in a cohort of patients attending intravitreal injection clinics. Prospective cross-sectional study of 380 patients attending the clinic for intravitreal injections at the Department of Ophthalmology at the Bern University Hospital. Thirty-two patients with SSP were identified and the anatomical features were assessed using anterior segment OCT. In our patient cohort, we found a SSP prevalence of 8.2%. Senile scleral plaques were easily identifiable using anterior segment OCT and were found at the insertion sites of the horizontal recti muscles. The mean horizontal diameter was 2.2 mm (±760 μm SD), the mean vertical diameter was 3.3 mm (±144 μm SD), and the average surface area was 5.3 mm(2) (±0.4 mm(2) SD). The mean senile scleral plaque thickness was 0.6 mm (±149 μm SD). The mean distance from the limbus was 2.24 mm for nasally located SSP and 3.22 mm for temporally located SSP. SSP are frequently encountered during intravitreal injections as they are located just anterior to the insertion sites of the horizontal recti muscles. Because the scleral stroma is rarefied and due to calcifications within SSP, these areas should be avoided when performing multiple intravitreal injections as this may result in rupture of the sclera.

A Case of Bilateral Senile Scleral Hyaline Plaques

A Case of Bilateral Senile Scleral Hyaline Plaques

A Cautionary Tale: Dosing Chemotherapy in Infants With Retinoblastoma

A Cautionary Tale: Dosing Chemotherapy in Infants With Retinoblastoma

Schwarzer Fleck am Auge

Senile scleral plaques are characterized by a calcification located at the insertion of the horizontal rectus muscles. As a possible cause for their development a combination of solar tissue damage and continuous mechanical stress is discussed. We present a case of a 76-year-old male whose wife noticed expulsion of a calcified scleral plaque while applying antiglaucoma eyedrops. The local antiglaucoma therapy was stopped and acetacolamide was administered. Local therapy consisted of hyaluronic acid eyedrop and calcium pantothenate and retinol palmiate eye ointment. This treatment led to a rapid reepithelialization. The expulsion of calcified senile scleral plaques is a described complication which can necessitate surgical treatment.

What Causes Nephrogenic Systemic Fibrosis?

What Causes Nephrogenic Systemic Fibrosis?

Nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis: a case series of nine patients and review of the literature

Nephrogenic fibrosing dermopathy/nephrogenic systemic fibrosis (NFD/NSF) is a fibrosing cutaneous disorder recently recognized to have systemic manifestations. The disease is characterized clinically by an acute onset of hardening and thickening of the skin of the extremities and trunk, often resulting in flexion contractures, and histologically by an increase in spindle-shaped cells, collagen, and sometimes mucin deposition in the dermis. The only common exposure amongst patients is acute or chronic renal failure. The pathophysiology of the disease remains to be elucidated, and there is currently no consistently effective treatment for this unremitting disease. We report a case series of nine patients seen at the University of Pennsylvania between 1998 and mid-2004. The clinical, laboratory, and pathologic data of these patients are reviewed. All patients had renal disease, received peritoneal or hemodialysis, and five had received at least one renal transplant. All patients had characteristic fibrotic cutaneous lesions involving the trunk, extremities, or both, and eight of the nine patients had scleral plaques. There were no other common findings amongst the histories, medications, or laboratory results of the patients. Our report confirms the clinical and histologic characteristics of NFD that have been described previously, and raises new issues regarding the possible subtypes. A review of the current literature stresses that further basic science and translational studies are necessary to understand the disease mechanism and to propose effective therapy, and emphasizes the importance of recognizing the systemic effects of NFD.

SENILE SCLERAL PLAQUES: Correspondence

SENILE SCLERAL PLAQUES: Correspondence

Spots Before the Eyes: A Prevalence and Clinicoradiological Study of Senile Scleral Plaques

AIMS: To investigate the prevalence and clinical associations of senile scleral plaques.METHODS: Unselected, consecutive computed tomographic (CT) images of elderly people were reviewed for the presence of calcification indicating senile scleral plaques.RESULTS: No definite calcification was seen in 100 men or 100 women aged 60–69 years; equivocal changes were seen in one woman. There were three definite examples and one equivocal case of calcification in 100 women and four definite cases in 100 men aged 70–79 years. However, in a group of 71 men and women patients aged 80 years or more, 16 definite cases were seen, indicating a prevalence of 22%.CONCLUSIONS: Apart from advanced age, and a mild association with the extent of calcification of the carotid siphon, no clinical or radiological features were identified which consistently characterized a total of 28 patients with this form of ocular calcification; an association with cataract probably reflected simply the recruitment base. Scleral plaques would appear to be a degenerative phenomenon without clinical significance, most likely to be detected in patients presenting with unrelated ophthalmological complaints.Moseley, I. (2000). Clinical Radiology55, 198–206.

Senile scleral plaques: CT.

I studied the CT appearances and the distribution of 109 asymptomatic calcified senile scleral plaques in 49 patients (98 eyes). The vast majority were just anterior to the insertion of the horizontal rectus muscles. The calcified plaques are variable in size, can be single or multiple, involve one or both eyes, and are only seen in elderly patients. Beam-hardening artifact and forward protrusion beyond the confines of the sclera are uncommon but potentially confusing features. Confusion with other pathology is unlikely with awareness of the plaques' asymptomatic nature and their clinical and CT appearances.

Calcified scleral plaques imaged on orbital computed tomography

Purpose: To identify calcified scleral plaques on orbital computed tomography. Methods: We identified all orbital computed tomographic scans at one center from January 1, 1994, through December 31, 1994. Orbital computed tomographic scans of 145 patients were reviewed to determine the presence or absence of the typical appearance of calcified scleral plaques on film. Results: Of the 145 scans reviewed, nine (6.2%) demonstrated calcified scleral plaques. Seven (22.6%) of 31 scans obtained on patients older than 70 years demonstrated calcified scleral plaques. Conclusions: Calcified plaques of the sclera commonly appear on orbital computed tomographic scans, especially in elderly patients. This entity should be included in the differential diagnosis of ocular calcifications. Familiarity with the computed tomographic findings of calcified scleral plaques may help ophthalmologists and radiologists distinguish them from intrascleral metallic foreign bodies.

Incidental Asymptomatic Orbital Calcifications

To use modern computed tomography (CT) imaging to quantify the incidence of asymptomatic incidental orbital calcifications and describe their histological features.One hundred orbital CT scans were reviewed. In addition, patients who had orbital calcification(s) detected on a brain CT scan were examined by the ophthalmology service.Of the orbital CT scans, 2% had bilateral drusen of the optic nerve head, 3% had calcified scleral plaques anterior to the medial or lateral rectus muscles, and 3% had bilateral ossification of the trochlear apparatus. Routine brain CT scans detected asymptomatic calcifications of the sclera and dura surrounding the proximal optic nerves.Incidental asymptomatic orbital calcifications are commonly encountered on modern high-resolution CT images of the brain and orbit. This article should help the clinician to confidently distinguish these densities from foreign bodies or pathological calcifications.

Senile scleral plaques: A histopathologic study using energy-dispersive X-ray microanalysis

The investigators reviewed the pathologic findings of 21 senile scleral plaques in 17 enucleated globes. Eyes were fixed in formalin and routinely processed for light microscopic examination. Two representative calcified scleral plaques were subjected to energy-dispersive x-ray microanalysis. Plaques were located in the sclera just anterior to the insertion of the horizontal rectus muscles. Microspic examination of the involved scleral disclosed a spectrum of histopathologic changes involving increased hematoxylinophilia of the scleral collagen, decreased stromal cellularity, the presence of scleral fibers with a unique corkscrew appearance, and calcium deposition. The calcified plaques contained calcium phosphate as indicated by histochemical methods and energy-dispersive x-ray microanalysis. Conjunctival elastosis was present in 12 of the 14 eyes in which sufficient conjunctiva was present for histologic evaluation. Accumulated actinic damage from solar irradiation may play a role in the pathogenesis of senile scleral plaques.

The conservative management of choroidal melanoma

The results of 32 choroidal melanomas managed by observation, Iodine-125 scleral plaques and local surgical excision are presented. Initially, 12 patients were managed by observation, and of these three continued to be managed by observation alone. Fifteen patients were managed with Iodine-125 scleral plaques and followed for an average of 15 months. The tumour regressed in 11, remained the same in three, and recurred in one case. The final visual acuity remained within two Snellen lines of that recorded preoperatively in 10 patients. Fourteen patients underwent local excision with an average follow-up of 31 months. These cases, in general, had larger tumours. The final visual acuity was within two Snellen lines of the preoperative vision in four patients. Five eyes required enucleation at a later date. Four of the five enucleations occurred earlier in the series. The management of choroidal melanoma remains controversial. Various methods of conservative treatment are described and the indications for conservative management by observation, scleral plaque and local excision are discussed.

Analysis of treatment results in 36 children with retinoblastoma treated by scleral plaque irradiation

This is a retrospective analysis of treatment results in 36 patients with retinoblastoma treated by the Radiation Oncology Department of Hahnemann University Hospital and the Division of Oncology of Wills Eye Hospital between January 1975 and December 1986. There were 14 females and 22 males; ages ranged from 2 months to 4 1 2 years of a e at presentation. Leukocoria was the most common clinical sign of presentation. These patients were treatedth external beam radiation therapy in combination with scleral plaque irradiation in 20 patients and with scleral plaque alone in 16 patients. Cobalt-60, Iodine-125, Iridium-192, and Ruthenium-106, scleral plaques were used. The dose delivered to the mid plane of the globe was 40 Gy and the scleral dose adjacent to the plaque was in the range of 180–200 Gy. The treatment was successful in 30 of 36 patients. Complications of radiation therapy were minimal in patients treated by scleral plaque alone. The advantages of this treatment modality are discussed.

Transmission Electron Microscopy, diffraction and electron probe X-Ray microanalysis of senile scleral plaques of the eye

Scleral plaques of the human eye are small, oval, grayish lesions located 1 to 2 mm in front of the insertion of the lateral rectus muscle. They are common in individuals over 50. Roper's review attributes them to "dehydration, sclerosis, and hyalinization of the connective tissue." Calcium carbonate was reported by Klein-Moncrieff and calcium sulfate and apatite mixed with gypsum by Cogan et al. In the present study light and electron microscopy along with electron diffraction and electron probe x-ray microanalysis (both wave length and energy dispersive) were used to examine the morphology and elemental composition of 12 eyes with the majority of them with unilateral and some bilateral plaques.