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 Table of Contents    
CLINICAL IMAGE
Year : 2022  |  Volume : 15  |  Issue : 3  |  Page : 411-412  

Trapped pearls in the eye


Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi, India

Date of Submission05-Jun-2021
Date of Decision10-Jul-2021
Date of Acceptance17-Jul-2021
Date of Web Publication16-Sep-2022

Correspondence Address:
Pooja Bansal
Guru Nanak Eye Centre, Maulana Azad Medical College, New Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ojo.ojo_174_21

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Keywords: Intermediate uveitis, OCT, subhyaloid deposits


How to cite this article:
Bansal P, Singh M, Thakar M. Trapped pearls in the eye. Oman J Ophthalmol 2022;15:411-2

How to cite this URL:
Bansal P, Singh M, Thakar M. Trapped pearls in the eye. Oman J Ophthalmol [serial online] 2022 [cited 2022 Dec 2];15:411-2. Available from: https://www.ojoonline.org/text.asp?2022/15/3/0/356253



A 32-year-old male presented with occasional floaters in the right eye (OD) for 1 month. The unaided visual acuity was 20/20 in both the eyes (OU). Anterior segment OU was unremarkable. Fundus examination OD revealed mild vitritis and multiple, round, discrete, creamish white epiretinal deposits on the posterior pole [Figure 1]a. Left fundus was within normal limits. Optical coherence tomography (OCT) macula showed posterior vitreous studded with inflammatory cells and partially lifted posterior hyaloid in the perifoveal area with round hyper-reflective subhyaloid deposits, giving a “trapped pearls” appearance [Figure 1]b. Fundus fluorescein angiography OD showed subtle peripheral vascular leak with no macular edema [Figure 1c]. There was no history of fever, cough, arthralgia, or any other systemic illness. Laboratory workup for tuberculosis, sarcoidosis, and syphilis did not reveal any abnormality. The patient was diagnosed to have intermediate uveitis (IU) in the right eye and was successfully treated with a short course of oral steroids. The vitritis and subhyaloid deposits resolved over a period of 5 months [Figure 1]d, [Figure 1]e, [Figure 1]f.
Figure 1: (a) Clinical photograph showing pearl white epiretinal deposits scattered over the posterior pole. (b) Spectral domain optical coherence tomography scan of the macula showing round hyperreflective deposits (red arrow) trapped under partially detached posterior hyaloid. (c) Fundus fluorescein angiography showing mild peripheral vascular leak. (d and e) Fundus picture and optical coherence tomography at 3 months revealed significant decrease in vitritis and subhayloid deposits (red arrow) and (f) Fundus photograph showing complete resolution of intraocular inflammation at 5 months

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Inflammatory cells can aggregate to form “snowballs” in the peripheral vitreous, often found in sarcoidosis, tuberculosis, Lyme disease, multiple sclerosis, idiopathic IU, and Candida endophthalmitis. String of pearls can be seen which consists of multiple collections of white cells, connected by a vitreous strand. They lie close to the retina, but not in contact with it. In this patient, posterior hyaloid was partially lifted in the right eye with the clumps of inflammatory cells trapped underneath it. These clumps were not connected to each other. Few were abutting the retinal surface causing back shadowing on OCT, and others were just in proximity to retina. These OCT findings have not been explained previously in the literature.[1],[2],[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Bonfioli AA, Damico FM, Curi AL, Orefice F. Intermediate uveitis. Semin Ophthalmol 2005;20:147-54.  Back to cited text no. 1
    
2.
Sève P, Cacoub P, Bodaghi B, Trad S, Sellam J, Bellocq D, et al. Uveitis: Diagnostic work-up. A literature review and recommendations from an expert committee. Autoimmun Rev 2017;16:1254-64.  Back to cited text no. 2
    
3.
Babu BM, Rathinam SR. Intermediate uveitis. Indian J Ophthalmol 2010;58:21-7.  Back to cited text no. 3
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