We thank Professor McLeod for his useful comments. The original pathologic valuation focused on differentiating amyloidosis and asteroid hyalosis and was performed by Dr Frederick Jakobiec at Massachusetts Eye and Ear Infirmary. We have also recently reviewed the pathologic features of the case again with Dr Thaddeus Dryja at Massachusetts Eye and Ear Infirmary.
According to Dr Jakobiec’s report, the diagnosis of amyloidosis was supported by the finding of eosinophilic birefringent lobules that stained positively with Congo red. Moreover, von Kossa and oil-red-O stains using standard techniques were negative. These findings reduce the likelihood of asteroid hyalosis because asteroid bodies consist of calcium hydroxyapatite crystals and phospholipids that usually stain positively with these stains.1 We agree that it would be interesting to perform additional studies, including electron microscopy analyses; unfortunately, we are not able to do so because no remaining specimen exists. In addition, Dr Jakobiec has since retired and is not available for further consultation.
Barouch F, Mukai S, Benson M. Amyloid or Asteroid?—Reply. Arch Ophthalmol. 2005;123(6):870–871. doi:10.1001/archopht.123.6.870-b
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