Senile 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.

Senil Skleral Plaklı Bir Olguda Künt Travma Sonrasında Gelişen Skleral Rüptür

Yetmiş sekiz yaşındaki erkek olgu, sol gözüne aldığı künt darbe nedeni ile kliniğimize başvurdu. Olgunun alınan öyküsünde sistemik hastalık ya da ilaç kullanımı yoktu. Sol göz ön segment muayenesinde subkonjonktival hemoraji ile birlikte temporalde skleral rüptür hattı izleniyordu. Arka segment muayenesi her iki gözde normaldi. Olgu acil şartlarda genel anestezi altında ameliyata alındı. Rüptür hattının 7/0 vikril ile sütürasyonu yapılırken, bu hattın hemen kenarında kalsifiye bir plak olduğu izlendi. Üst limbal bölgede dikkatli şekilde diseksiyon yapılarak kalın tenonlu konjonktival greft alındı. Geniş konjonktival greft rüptür hattına yerleştirildi ve 10/0 naylon sütür ile sağlam skleraya sütüre edildi. Cerrahi sonrası 6 aylık takiplerde herhangi bir komplikasyon izlenmedi.

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

Plaque sclérale sénile associée à une sclérite chez un patient atteint d’une polyarthrite rhumatoïde

Senile scleral plaque is an age-related, commonly asymptomatic hyaline degeneration of the sclera. We report a case of calcific scleral plaque associated with anterior scleritis in an elderly patient with rheumatoid arthritis. Response to anti-inflammatory treatment was favorable.

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.

Scleral perforation secondary to a spontaneously dehisced senile scleral plaque: clinical features and management

Scleral perforation secondary to a spontaneously dehisced senile scleral plaque: clinical features and management

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.

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.

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.

Radiographic abnormalities in eyes with retinoblastoma and other disorders.

The importance of radiographic examinations of pathological ocular material is stressed. Characteristic ocular radiodensities are observed with retinoblastomas, calcified cataracts, senile scleral plaques, intraocular ossification, and a variety of radiodense foreign bodies. Radiographs supplement other techniques for the documentation of ocular abnormalities and in certain instances may be the ideal method. They also permit the precise localisation of radiodense foreign bodies that need to be removed prior to the processing of tissue for microscopic examination. In certain situations valuable data can be obtained by x-ray examinations of embedded material. Retinoblastomas have an extremely high incidence of radiodensities with a characteristics appearance. This finding stresses the clinical importance of utilising and developing clinically applicable techniques for the detection of calcification in patients with suspected retinoblastomas.

Detection of Senile Scleral Plaque after Head Trauma

Senile scleral plaques are late onset ocular calcifications, and are usually detected incidentally on orbital computed tomography scan following trauma. This report is of 4 elderly patients with senile scleral plaques who were admitted to the emergency room following trauma to the head. A head/orbital computed tomography scan was performed as part of the routine examination. In all 4 patients, computed tomography scan revealed a clear retina and no scleral perforation or foreign body intrusion, but bilateral radiodense areas were located anterior to the insertion of the horizontal rectus muscles. These areas were diagnosed as senile scleral plaques. Even though these ocular calcifications are benign, they have important prognostic implications, and should therefore be identified correctly and not confused with other ocular pathologies.