Spider silk in the eye

This is the right eye of a woman in her late 60s who presented with a dark floating shadow in her vision (fig 1). She had good visual acuity bilaterally, and slit lamp examination showed scattered peripheral punctate opacities in the right vitreous body and linear opacities resembling spider silk.bmj;383/nov16_4/e076906/F1F1f1Fig 1Differential diagnoses of spider silk-like opacities include vitreous amyloidosis, endophthalmitis, asteroid hyalosis, and synchysis scintillans. As the patient had a family history of amyloidosis, an identified heterozygous mutation in her transthyretin (TTR) gene,1 and no features of systemic disease, a clinical diagnosis of vitreous amyloidosis was made. Vitreous amyloidosis is a group of diseases in which insoluble fibrillar aggregates accumulate in the vitreous body because of protein conformation abnormalities.2 Vitrectomy may be considered for those with severe visual impairment, and subsequent Congo red staining can provide histological confirmation of the diagnosis. As this patient had good visual acuity, she was…
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