Author: Karl Brasse
Co-authors:
Abstract
Purpose:Avoiding Pars plana Vitrectomy in a 24 year old patient with massive impairment of visual function in daily life.
Setting/ Venue:
Multimedia presentation
Methods:
1. Diagnostic: Haag Streit Slit Lamp Photograpy and Movie documentation of vitreous amyloidosis in ultra high quality
in particular of the opaque and intratransparent posterior detached vitreous membrane.
2. Building a 3 D modell of the complex vitreous pathology
2. Sharing these images/movies/ 3D model with international colleagues to come to a diagnostic conclusion of this rare disease
3. Performing successfully a YAG Laser T-Membranotomy to open up the optical axis
Results:
Improvement of visual accuity
OS 20/100 to OS 80/100
Conclusions:
This 24 year old patient was already scheduled for pars plana vitrectomy. Histology was planned to come up with a diagnosis of the vitreous condition. She was looking for an alternative treatment and visited my clinic in January 2015. Telemedicine sharing my findings was helpful to come to a diagnostic conclusion. David McLeod FRCS said: "Nothing else in the vitreous looks like amyloid. Vitreous infiltration by amyloid proteins has a pathognomonic biomicroscopic appearance. Biopsy is not necessary."
Research for an therapeutic alternative revealed the option to perform a YAG Laser T-Membranotomy first described by Cees van der Windt.
The YAG laser treatment was successfully performed in several sessions in February 2015 without any complications achieving full visual rehabilitation. Still on her last check up visit in January 2022 no side effects like an induced cataract could be diagnosed. She was able to pass her driving license and to finish her university degree.
To my knowledge this is the first patient treated with YAG Laser for this rare disease.
