Giant anterior scleral staphyloma caused by blunt ocular trauma: a case report

BACKGROUND

Anterior scleral staphyloma is a relatively rare disease characterized by thinning and expansion of sclera. We described the clinical presentation, diagnosis and treatment of a case with giant anterior scleral staphyloma caused by blunt ocular trauma.

CASE PRESENTATION

A 24-years-old male, presented with a black cyst-like mass protruding from the right eyeball for 9 years after a history of glass crush contusion. The ultrasound biomicroscopy examination showed two cysts in the right eyeball. The larger one was about 5.92 mm*4.69 mm in size and the scleral lacerations were connected to the posterior chamber below the cyst. For treatment, resection of the anterior scleral staphyloma and the scleral patch graft transplantation was performed. The vision of the patient was improved compared with that before surgery. There were no obvious complications.

CONCLUSION

The clinical presentation, diagnosis, and treatment of the case with giant anterior scleral staphyloma can provide a reference for the management of anterior scleral staphyloma. Surgical resection and scleral patch graft should be a good option for the treatment of giant anterior scleral staphyloma.

[Capabilities of optical coherence tomography in examination of senile scleral plaques]

Senile scleral plaque (SSP) is a degenerative disease of the sclera manifested by the appearance of gray spots with clearly defined borders anteriorly from the insertion site of horizontal rectus muscles. Even with minimal changes over time changes over time are minor, SSP weakens the structural function of the sclera and creates a risk of a complicated course associated with scleromalacia. Interest in the study of SSP is increasing due to the growing number of transscleral intravitreal injections.

PURPOSE

To assess the morphological characteristics of SSP using spectral optical coherence tomography (OCT).

MATERIAL AND METHODS

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.

RESULTS

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.

CONCLUSION

Updated information about SSP structure can be used in the development of standard surgical algorithms contributing to prevention of postoperative complications.

CLINICAL AND MORPHOLOGIC FEATURES OF POSTERIOR STAPHYLOMA EDGES BY ULTRA-WIDEFIELD IMAGING IN PATHOLOGIC MYOPIA

PURPOSE

To investigate morphologic features along posterior staphyloma edges in eyes with pathologic myopia using ultra-widefield optical coherence tomography imaging.

METHODS

Highly myopic patients (refractive error < -8 diopters or axial length ≥26.5 mm) were consecutively examined by prototype ultra-widefield optical coherence tomography with a scan width of 23 mm and depth of 5 mm. Staphyloma edges were assessed for scleral, choroidal, and retinal status, as well as measurements of angle size. Findings were correlated with pigmentary changes observed on Optos fundus photography, and multivariate logistic regression analyses were performed.

RESULTS

In 164 eyes diagnosed with posterior staphyloma by ultra-widefield optical coherence tomography, choroidal thinning and scleral protrusion were hallmark features of staphyloma edges, observed simultaneously in more than 95% of staphylomatous eyes. Outer neural retinal thinning was observed in 80 eyes (48.8%), whereas 15 eyes (9.1%) showed retinal pigment epithelium damage. The mean angle at the staphyloma edge was 23° ± 12.4° (range 8° to 77°). Larger angles were significant predictors of retinal thinning (adjusted odds ratio: 1.17, confidence interval: 1.09-1.25), and the staphyloma was detected by Optos pseudocolor fundus photography (adjusted odds ratio: 1.08, confidence interval: 1.02-1.15).

CONCLUSION

These morphologic findings may provide a basis for exploring the natural evolution of posterior staphyloma as part of the development of pathologic myopia.

Preserved corneal lamellar transplantation for infectious and noninfectious scleral defects: Three case reports and literature review

RATIONALE

: Reinforcement of thinned or necrotizing sclera has been conducted using various materials, including allogeneic sclera, allogenic cornea, amniotic membrane, fascia lata, pericardium, periosteum, and perichondrium. Among them, good outcomes have traditionally been obtained using preserved scleral grafts. However, scleral patch grafts have complications such as graft retraction, thinning, dehiscence, and necrosis. Furthermore, to promote epithelial healing, scleral patch grafting must be accompanied by procedures such as amniotic membrane transplantation (AMT) or grafting using conjunctival flaps or autografts. Recently, acellular preserved human corneas have been used in various ophthalmic surgeries, with emerging evidence supporting its use for treating scleral defects as an option that does not require AMT or conjunctival autografting. We investigated whether corneal patch grafting would show wound healing and tectonic success rate outcomes comparable to those of existing techniques.

PATIENT PRESENTATION

: Three patients presented with intractable ocular pain. Slit-lamp examination showed marked scleral thinning at the nasal side.

DIAGNOSIS

: Scleral thinning progressed with conservative treatment; microbial staining and culturing were performed. Infectious or non-infectious scleritis was diagnosed according to slit-lamp examination and microbial culture results.

INTERVENTIONS

: A preserved corneal lamellar patch was grafted at the scleral thinning area.

OUTCOMES

All patients achieved tectonic success with reduction of inflammation following corneal patch grafting. Two patients achieved complete re-epithelialization within 7 days, while 25 days were required for the third patient. No patients experienced graft thinning, rejection, or infection.

LESSONS

: Our report suggests the feasibility of using acellular preserved human cornea patch grafts to reinforce inflammatory scleral defects and obtain successful outcomes in terms of wound healing. This technique shows a comparable tectonic success rate and superior effect on scleral defect healing without the need for adjunctive AMT or conjunctival autografting.

Bandage lens for treatment of corneosclera melting two weeks after pterygium surgery: A case report

INTRODUCTION

Pterygium is a common chronic ocular surface condition in ophthalmology.At present, the main treatment modality is surgical resection. Although the recurrence rate can be controlled to varying degrees, some patients can still develop serious complications, such as scleral melting, corneal melting, and even corneal perforation.We report a case of severe corneal and scleral melting after pterygium surgery treated with a bandage lens.

PATIENT INFORMATION

A 60-year-old male who developed corneoscleral melting after pterygium surgery.

DIAGNOSIS

This patient was diagnosed with corneoscleral melting.

INTERVENTIONS

This patient was treated with a bandage lens and eye drops.

OUTCOMES

He was treated with a bandage lens, and the tear break-up time (BUT) was prolonged. After 12 days the cornea and sclera were completely cured and the bandage lens was removed after one month.

CONCLUSION

After pterygium surgery, various factors affect the occurrence of serious complications of autolysis. Mainly on ocular parts, such as the cornea and sclera, a bandage lens can stabilize the ocular surface tear film and prolong the tear break-up time (BUT), effectively prevent corneoscleral melting and promote corneoscleral cure.

Sclerokeratoplasty for the early management of acquired anterior staphyloma

Objective: To report a case of acquired anterior staphyloma after trauma and its first surgical management. Methods: This is a case report of a 17-year-old man who had a history of trauma by insect on the right eye, without a previous history of eye conditions, and evolved with local pain and low visual acuity. The ophthalmological exam showed light perception visual acuity in right eye and 1,0 in left eye, anterior staphyloma and impossibility to blink. The first surgical procedure proposed was sclerokeratoplasty and the second one an optical transplantation but, after step one, the patient did not return to the service and missed the follow-up. Results: Sclerokeratoplasty was proposed once the posterior segment and the crystalline were preserved in topical position. The anterior tumor was excised in free-cut and corneal-scleral graft sutured in single points with 10-0 mononylon. Gatifloxacin 0.3% with Prednisolone Acetate 1%, Epitezan® and Atropine 1% were prescribed immediately postoperative. After 60 postoperative days, he maintained the use of Dexamethasone 0.1% and Atropine 1% and the patient had visual acuity of perception of hand movement in the affected eye. Conclusion: Few treatment options are alternatives to evisceration. In this case report, the sclerokeratoplasty was the chosen technique for the initial management. The second step was not possible due to loss of follow-up. Despite the uncomplicated procedure, we need greater compliance by the patient to conclude the treatment.

The Role of Serum Calcium in the Development of the Acute Red Eye in Chronic Renal Failure

In patients with chronic renal failure treated by long-term dialysis, inflammatory reactions occasionally develop in the bulbar conjunctiva; the episcleral tissue is only rarely involved. Diffuse congestion of both the conjunctiva and episclera was present in 5.3% of our patients and was associated with a sudden, marked rise in serum calcium. Histopathological examination suggests that this form of hyperemia, clinically preceded by a marked shedding of calcific precipitates, is the result of a neurogenic-driven inflammatory reaction in which mast cell degranulation is mediated by the axon reflex. Focal hyperemia associated with elastosis ("pingueculitis") was present in 6.7% of the patients. This type of hyperemia was observed after an extended period of increasing levels of BUN and seemed independent of both serum calcium and phosphorus. Diffuse hyperemia of the conjunctiva, being clinically distinctly different from the combined diffuse conjunctival and episcleral hyperemia, was also observed in 6.7%. Diffuse conjunctival hyperemia seemed to be associated with low BUN. Here, again, there was no association with serum calcium and phosphorus levels.

A rare case of a direct ocular contact burn to the right eye

Ocular thermal burns represent an oculoplastic emergency, with the potential for blindness owing to limbal ischaemia. We present a rare case of a 66-year-old man who sustained a direct thermal contact burn to the right eye.

Presentation and Management Outcomes of Corneal and Scleral Perforations in Geriatric Nursing Home Residents

We compared the clinical presentation and treatment outcomes of corneal and scleral perforations in geriatric nursing home residents, geriatric community residents, and non-geriatric population. The medical records of patients who were treated for corneal and scleral perforations at the Prince of Wales Hospital, Hong Kong between January 1, 2004 and May 1, 2013, were reviewed retrospectively. Of 144 cases, 53 (37%) occurred in the geriatric population, of which 16 (11%) lived in nursing homes, and 37 (26%) were community residents. There were 91 (63%) patients in the non-geriatric group. The mean age of the patients in nursing home geriatric group was 86.5 years (87.5% females). The most common etiology of perforation was trauma. Rupture due to fall was more common in geriatric patients (P < 0.001) whereas laceration due to penetrating eye injury was more common in non-geriatric patients (P < 0.001). There were more cases of infection leading to spontaneous perforation in geriatric nursing home group compared to the other groups (P = 0.001). In the geriatric nursing home group, visual acuity at presentation (P < 0.001) and postoperative visual acuity (P = 0.012) was worse compared to the other groups. Our study showed that corneal and scleral perforations in the geriatric nursing home residents carry a poor visual prognosis. The causes and anatomical outcomes of such events in geriatric age group differ from those in the general population. In our study, geriatric patients residing in nursing homes had worse baseline as well as posttreatment visual acuity, compared to community residents.

Ocular manifestations in porphyria cutanea tarda

A 24-year-old man presented with pain, sticky discharge and loss of vision in the right eye. He has had typical skin manifestations of porphyria cutanea tarda (PCT) since 6 years and ophthalmological symptom for 6 weeks. On ophthalmological examination, visual acuity was light perception in the right eye and 6/12 in the left. There were bilateral, symmetrical temporal scleromalacia along with temporal corneal melting in both eyes and perforation in the right eye. Ultrasonography B-scan (USG B-scan) revealed a retinal detachment in the right eye. Artificial tear instillation was started every hour along with topical antibiotic coverage in both eyes. Additionally, ultraviolet protective sunglasses and hat for photo-protection was advised. The vision in the right eye improved to 5/60 along with subsidence of retinal detachment on repeat USG B-scan after 3 weeks.

On the ocular findings in ochronosis: a systematic review of literature

BACKGROUND

Ochronosis/Alkaptonuria is a tyrosine metabolism disorder where accumulation of homogentisic acid, in eye, skin, cartilage and several other connective tissues leads to a black pigmentation of the affected tissues. It is autosomal-recessive inherited in men with a frequency of 1-9/1,000,000. While it is clear that pigment deposits lead to joint destruction, renal stone formation and cardiac valvulopathy respectively, the significance of ocular findings is still unclear. We therefore aim to evaluate the frequency and clinical significance of ocular findings in ochronosis and discuss possible therapeutic options.

METHODS

Systematic review of literature via Medline and Web of Science. Only case reports in English, German, French, Spanish or Italian documenting detailed ophthalmologic examination were included.

RESULTS

Our search revealed 36 case reports including 40 patients. Average age at the onset of ocular signs was 40.6 years. The most frequent sign was symmetric brown sclera pigmentation present in 82.5 percent of the patients. "Oil-drops", brown pigment spots in the limbus are generally considered pathognomonic but were a little less frequent (75 percent). Vermiform pigment deposits at the level of the conjunctiva or increased conjunctival vessel diameter is also frequent. We found an increased incidence of central vein occlusion and elevated intraocular pressure going along with chamber angle hyperpigmentation. Another condition observed twice is rapid progressive astigmatism attributable to corneoscleral pigment accumulation.

CONCLUSION

Our observations suggest that ocular findings are of double relevance. First, characteristic ocular findings can anticipate the time of diagnosis and second, ocular findings may complicate to various conditions putting sight at risk. Opthalmologists and general physicians should be aware of both. Therapeutic options include protein restriction, administration of high dose vitamin C or nitisonone. Evidence for all of them is limited.

Large post-traumatic ciliary staphyloma--a simple, safe and successful management

Surgical management of scleral staphylomas is challenging and is usually associated with poor visual outcome. A middle aged lady developed a large post-traumatic scleral staphyloma following injury with a cow's horn. She sought treatment for poor vision and cosmetic blemish. She was satisfactorily managed by surface diathermy and closure of defect with partial thickness rotational scleral autografts and her corrected visual improvement was 6/12.

[Repair of a leaking bleb filtration with conjunctival and amniotic membrane transplantation]

CLINICAL CASE

A 71-year-old woman presented with a leaking bleb after a combined phacotrabeculectomy performed 13 years ago. To construct a new filtering bleb, the necrotic area was fully excised. The amniotic membrane was inserted over the scleral flap underneath healthy conjunctiva edges. A conjunctiva-Tenon autograft from the contralateral eye was sutured and was sealed with fibrin adhesive.

DISCUSSION

We propose a new surgical technique to repair late leak failures after trabeculectomy with mitomycin C in blebs with a large avascular area. Transplantation of amniotic membrane and conjunctival autograft may be used to repair late leak failures with inadequate conjunctiva to advance.

Scleral jaundice may be unilateral: a case report

Unilateral scleral jaundice is a rare and puzzling clinical phenomenon. Students and health practitioners are further bewildered and confounded when confronted with this subject during academic sessions, including examinations. This is partly attributable to a situation where both trainers and trainees alike rarely encounter such a case. We present this case report to draw attention to this rare type of sclera jaundice and to proffer explanations for its occurrence.

Traumatic and spontaneous scleral rupture and uveal prolapse in osteogenesis imperfecta

Three cases of severe globe injuries due to scleral fragility in osteogenesis imperfecta patients between the ages of 4 and 15 years are reported. Patient 1 had complete loss of vision. Patients 2 and 3 suffered non-sight-threatening scleral perforation. All 3 patients had no previous knowledge of recommendation for eyewear protection.

Scleral thinning after transcleral diode laser cycloablation

BACKGROUND AND OBJECTIVE

To highlight the occurrence of scleral thinning after transcleral diode laser cycloablation therapy.

PATIENTS AND METHODS

A retrospective chart review was done of consecutive patients from the glaucoma and pediatric ophthalmology clinics of a tertiary eye care center in whom the presence of scleral thinning was noted after transcleral diode laser cycloablation therapy.

RESULTS

Eleven eyes of 9 patients with various types of glaucoma (traumatic, congenital, juvenile, steroid induced, uveitic, and secondary angle closure) were found to have scleral thinning after undergoing transcleral diode laser cycloablation therapy for refractory glaucoma. Seven patients had undergone only 1 session before new scleral thinning was noted. Two patients had bilateral transcleral diode laser cycloablation therapy and subsequent bilateral thinning.

CONCLUSIONS

Scleral thinning may occur after diode laser cycloablation therapy even with only 1 treatment session and intact sclera, and young patients may be more susceptible to thinning.

Spontaneous intraocular lens extrusion in a patient with scleromalacia secondary to herpes zoster ophthalmicus

We report a case of spontaneous intraocular lens (IOL) extrusion in association with scleromalacia 10 years after uneventful endocapsular surgery. The patient had a history of iridocyclitis secondary to herpes zoster ophthalmicus in the affected eye. A minimally invasive approach involving repositioning the IOL and closure with a conjunctival flap resulted in restoration of visual acuity.

Bilateral scleromalacia in a case of congenital erythropoietic porphyria

A 25-year-old woman presented with gradual dimness of vision in the left eye with history of recurrent cutaneous bullae, photosensitivity and passage of red coloured urine. Examination revealed cataract and high intra-ocular pressure in left eye and symmetrical areas of scleral thinning in both eyes. Systemic features of the patient pointed towards congenital erythropoietic porphyria, which was established by laboratory investigations.

Ocular lesions in Watanabe heritable hyperlipidemic rabbits

Hyperlipidemic ocular lesions are described for Watanabe heritable hyperlipidemic (WHHL) rabbits. Male WHHL rabbits 8 months old exhibited serum hyperlipidemia and ophthalmoscopically yellowish-white lesions along the corneoscleral junction and in the iris. Histopathologically, foamy macrophages aggregated in the stroma of the cornea, iris, and ciliary body were observed. These findings have been interpreted as lipid keratopathy. In addition, multiple clusters of a large number of foamy macrophages occurred throughout the choroid and sclera in association with the blood vessels. The lesions in the choroid and sclera could not be detected ophthalmoscopy, yet were much more prominent than those in the cornea, iris, and ciliary body, suggesting greater involvement and earlier onset of lipidosis at these sites associated with hyperlipidemia in WHHL rabbits.

Pigmented Episcleral Deposits after Brachytherapy of Uveal Melanoma

PURPOSE

To describe the characteristics and evolution of pigmented episcleral deposits after brachytherapy for uveal melanoma to determine their origin and association with melanoma-related mortality.

DESIGN

Noncomparative case series.

PARTICIPANTS

Two hundred eleven patients (108 males, 103 females; median age, 61 years; range, 14-88 years) who were treated with a single ruthenium and iodine plaque therapy (median dose to tumor base, 475 Gy and 392 Gy, respectively) for a choroidal and ciliary body melanoma. Median tumor diameter and height were 12 mm and 5.5 mm, respectively. Eighty-eight patients were treated prospectively during the study.

METHODS

The number and location of pigmented episcleral deposits were recorded under the slit lamp during each visit after brachytherapy. The association of the deposits with tumor characteristics and survival was analyzed with logistic regression and Kaplan-Meier analysis, respectively.

MAIN OUTCOME MEASURES

Number and location of episcleral deposits, melanoma-related mortality.

RESULTS

The pigmented episcleral deposits ranged from black and brownish spots to slightly thickened patches. Most deposits appeared within the first 6 months after brachytherapy. By 1 year, 85% (95% confidence interval, 77-93) of eyes had at least 1 deposit (median, 6). The deposits increased in number until 7 years from irradiation, and decreased with increasing distance from tumor center. An association between the number of deposits at 1 and 2 years and subsequent melanoma-related mortality could not be confirmed (P = 0.80 and P = 0.31, respectively).

CONCLUSIONS

Pigmented macrophage-related episcleral deposits are found in most eyes with uveal melanoma after brachytherapy. Their association with plaque size and isotope rather than with tumor size suggests that radiation atrophy of retinal pigment epithelium and choroid in addition to tumor regression contributes to the formation of the deposits. Knowledge of their existence may save patients from unnecessary enucleation.

Atrophic chorioretinal scar and focal scleral bowing following thermochemotherapy with a diode laser for retinoblastoma

One of the treatment options for intraocular retinoblastoma is thermochemotherapy with diode laser combined with chemotherapy. Very little is known about the evolution of laser scars resulting from diode laser treatment for retinoblastoma. We report a case of atrophic chorioretinal scar and focal scleral bowing after thermochemotherapy with diode laser for retinoblastoma.

TREATMENT OF RETINAL DETACHMENT RESULTING FROM POSTERIOR STAPHYLOMA–ASSOCIATED MACULAR HOLE IN HIGHLY MYOPIC EYES

PURPOSE

To evaluate the surgical outcome of retinal detachment resulting from a posterior staphyloma-associated macular hole in highly myopic eyes.

METHODS

Fifty-seven consecutive highly myopic eyes with retinal detachment resulting from a posterior staphyloma-associated macular hole diagnosed between January 1993 and June 2003 were retrospectively studied. Anatomical reattachment of the retina and best-corrected visual acuity were measured.

RESULTS

Six different operative methods were used to treat this condition with diverse retinal reattachment rates: long-acting gas tamponade only (12.5%); pars plana vitrectomy (PPV) with long-acting gas tamponade (42.8%); PPV with epiretinal membrane (ERM) peeling and long-acting gas tamponade (50.0%); encircling scleral buckling combined with PPV and long-acting gas tamponade (57.1%); encircling scleral buckling combined with PPV, ERM peeling, and long-acting gas tamponade (40.0%); and encircling scleral buckling combined with PPV and silicone oil tamponade (75.0%). Overall, successful retinal reattachment was achieved in 25 (43.9%) of 57 eyes after the first surgery. However, the ultimate success rate of retinal reattachment was 77.2% (44 of 57 eyes) after subsequent surgery. The mean preoperative visual acuity +/- SEM (in logarithm of the minimal angle of resolution units) was 2.08 +/- 0.55, and the mean postoperative visual acuity +/- SEM was significantly increased to 1.87 +/- 0.54 at the last follow-up (P = 0.038). The major cause of recurrent retinal detachment in the long-acting gas tamponade group was nonclosure of the macular hole. For vitrectomized eyes, the major cause was reopening of the macular hole, even with ERM formation and proliferative vitreoretinopathy. There was no obvious correlation between the extent of the detachment or lens status and the reattachment rate.

CONCLUSIONS

The major causes of recurrent retinal detachment in the long-acting gas tamponade and vitrectomized groups were nonclosure of the macular hole and reopening of the macular hole, respectively. Furthermore, a lesser extent of retinal detachment was not associated with a higher anatomical success rate. More aggressive treatment such as silicone oil tamponade may need to be performed to overcome reduced natural adhesion due to posterior staphyloma with marked chorioretinal atrophy. Failure to initiate aggressive treatment can result in an unsatisfactory outcome and repeated surgery.

Scleral Melting in a Patient With Carotid Artery Obstruction

PURPOSE

To report a case of severe scleral melting in a patient with carotid artery obstruction.

METHODS

This is an observational case report. We reviewed the patient's chart and the available literature on ocular melting and ocular ischemia.

RESULTS

A 71-year-old man with a history of carotid vascular disease and a blind left eye due to a previous vascular accident developed scleral melting of the right eye. Despite frequent lubricants, systemic immunosuppressives, and repeated conjunctiva transplants, the thinning progressed and his visual acuity deteriorated. Intensive screening for possible underlying diseases revealed no infectious or collagen vascular disease. Magnetic resonance angiography, however, showed a subtotal obstruction of the right internal carotid artery. Further investigations revealed coronary artery obstruction. Carotid surgery combined with coronary artery bypass grafting was performed, and a stable ocular situation was achieved.

CONCLUSIONS

Although a causal factor cannot always be determined, corneoscleral melting should be regarded as a manifestation of underlying systemic or ocular disorders. In the absence of more common causes of corneoscleral melting, a thorough workup is warranted and might reveal life-threatening disorders.

Localized, extreme scleral thinning causing globe rupture during strabismus surgery

Eye muscle surgery in strabismus patients usually is without serious, vision-threatening complications. The risk of scleral perforation during strabismus surgery has been reported to approximately 1% but usually without serious sequelae. Inadvertent perforation may occur during muscle disinsertion or during muscle reattachment. The risk of perforation is increased in myopic eyes, and the risk is higher in recessions than in other strabismus procedures. We report a case of sudden rupture of the globe during a recession procedure on the superior rectus muscle caused by a localized area of extreme scleral thinning adjacent to the muscle insertion. To our knowledge, this serious complication has not previously been reported.

Peripapillary intrachoroidal cavitation in myopia

PURPOSE

To report optical coherence tomography (OCT) findings in disorders recently described as peripapillary detachment in pathologic myopia (PDPM).

DESIGN

Observational case report.

METHODS

OCT, fluorescein, and indocyanine green angiography.

RESULTS

A 69-year-old woman presented with bilateral yellow-orange peripapillary area at the inferior border of the myopic conus, typical of PDPM. OCT showed this area as a large intrachoroidal hyporeflective space located below the normal plane of the retinal pigment epithelium. There was no detachment of the retinal pigment epithelium which appeared flat.

CONCLUSIONS

OCT findings suggest calling this anomaly peripapillary intrachoroidal cavitation, instead of peripapillary detachment in pathologic myopia.

[A blinding orphan disease: high myopia]

High myopia is the fifth cause of legal blindness in France. Myopic blindness is somewhat neglected, however, because it is poorly understood and untreatable. Certain mechanisms of this visual handicap have been elucidated by the use of new imaging technologies, raising new therapeutic possibilities.

[Prevention of spontaneous scleral perforation during repeated surgery for regmatogenic retinal detachment]

Scleroplastic operations, such as circlage, filling, and their combination widely used in modern surgery so far, have a variety of advantages; however, their drawbacks may also cause severe complications. Among them, there is scleral decubitus (erosion) that is detectable at resurgery when the retina has failed to adjoin after the first operation or when recurrent retinal detachment has developed. The occurrence of this complication makes it impossible to perform an adequate pressing-in due to the fact that spontaneous scleral perforation may occur, which makes it necessary to conduct scleroplasty in this area. For this situation, the authors propose a procedure for surgically treating retinal detachment during re-interventions, which makes it possible to prevent spontaneous scleral perforation, to diminish surgical traumaticity, and to perform a necessary adequate pressing-in for blocking ruptures of the retina with its subsequent adjoining.

Surgical Management of Scleral Defects

PURPOSE

To evaluate the results of surgical management of scleral defects using fascia lata, cornea, and sclera as graft materials.

METHODS

The scleral defects of 8 patients were repaired surgically. Six had previous intraocular surgery, 1 had eye trauma, and the other had both intraocular surgery and trauma. Corneoscleral grafts were used in 3 eyes, scleral grafts in 4, and fascia lata was used in 1 eye.

RESULTS

In 7 patients, we achieved the desired cosmetic and tectonic success. During the follow-up period, a recurrent defect was seen in 1 patient, and a second operation was required.

CONCLUSIONS

Surgical techniques using fascia lata, corneal, and scleral grafts are effective for scleral defects.

Sclerochoroidal calcification in a patient with classic Bartter's syndrome

PURPOSE

To report sclerochoroidal calcification in a patient with classic Bartter's syndrome.

DESIGN

Observational case report.

METHODS

A 42-year-old woman with a 26-year history of classic Bartter's syndrome was found to have bilateral fundus tumors. The patient presented initially with quivering lips and hand stiffness at age 6 years but was not diagnosed until age 16 years. Treatment included magnesium and potassium supplementation and Amiloride therapy.

RESULTS

On ocular examination, there were multifocal, yellow-white, geographic, solid choroidal lesions along the superior and inferior retinal vascular arcades in both eyes. Ultrasonography showed echogenic, placoid calcified lesions at the level of the sclera and choroid, consistent with bilateral sclerochoroidal calcification.

CONCLUSIONS

Sclerochoroidal calcification can be associated with classic Bartter's syndrome.

Scleral cyst formation following extracapsular cataract extraction

Two patients who underwent extracapsular cataract surgery through corneal incisions developed scleral cysts 2 and 6 years later, respectively. The cysts involved the sclera without extension into the cornea or anterior chamber. To prevent further thinning of the sclera, only the anterior walls were excised and the posterior walls were mechanically debrided using alcohol and sponges. Histopathologic examination supported the clinical diagnosis of scleral cysts. No recurrence was seen. Scleral cyst formation may be encountered as a late complication of cataract surgery. Excision of the anterior wall coupled with removal of the epithelial lining of the posterior wall with alcohol may considerably lessen the likelihood of recurrence.