|Year : 2023 | Volume
| Issue : 1 | Page : 180-181
Leaking cystoid cicatrix in an acquired intercalary staphyloma
Nibedita Das, Shweta Malejan
Department of Cornea, Disha Eye Hospitals, Kolkata, West Bengal, India
|Date of Submission||01-Aug-2021|
|Date of Decision||26-Aug-2021|
|Date of Acceptance||11-Jun-2022|
|Date of Web Publication||21-Dec-2022|
Disha Eye Hospitals, 88 (63A), Ghoshpara Road, Barrackpore, Kolkata - 700 120, West Bengal
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Keywords: Cystoid cicatrix, patch graft, staphyloma
|How to cite this article:|
Das N, Malejan S. Leaking cystoid cicatrix in an acquired intercalary staphyloma. Oman J Ophthalmol 2023;16:180-1
| Case Report|| |
A 56-year-old lady presented with gritty sensation, watering in the left eye for the past 4 months. She had cataract surgery 6 months ago but denied any history of trauma. Her distant visual acuity in the left eye was 6/60 with Snellen's chart which improves to 6/12 with pinhole and in the right eye was 2/60.
On examination, left eye has clear cornea with a blackish, lobulated, cystic mass (8 cm × 5 cm × 9 mm) encompassing 2 o'clock hours of the superior limbus [Figure 1]a, which was covered with pseudomembrane, but leaks on pressure [Figure 1]b. Anterior chamber (AC) depth was irregular with up drawn pupil. Intraocular pressure (IOP) was 16 mmHg in the left and 15 mmHg in the right with normal posterior segment. Anterior-segment optical coherence tomography showed lobular hyporeflective spaces with hyperreflective membrane and few hyperreflective dots [Figure 1]c. The mass was excised with scleral patch graft and histopathology showed epithelial, fibrous layer, mononuclear, and uveal pigment laden cells.
|Figure 1: (a) Clinical photomicrograph of the left eye showing staphyloma with cicatrix. (b) Fluorescein stain with blue filter demonstrating leaking of the cicatrix (positive Seidel's test). (c) Anterior-segment optical coherence tomography of the mass showing hyporeflective lobulated spaces covered by hyperreflective membrane and several hyperreflective dots suggesting macrophages and debris|
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| Discussion|| |
Staphyloma is incarceration of the uvea through gap or weakened portion of ocular coating. In relation to equator of the globe, it is classified as anterior, intercalary, ciliary, equatorial, and posterior staphyloma. Causes of staphyloma may be due to poor strength of surgical wound, trauma, infection, and chronic inflammation in some systemic inflammatory disorders.
Thinning of the staphyloma leads to cicatrix cyst formation that predisposes leaking and causes chronic hypotony, pthisis bulbi, endopthalmitis or panophthalmitis. So this condition requires urgent intervention.
Patching with lubricant and antibiotic will only help in symptomatic relief and infection prevention. Tissue glue with bandage contact lens may seal the leakage, but it can be misplaced easily. Hence, excision of the staphyloma with scleral patch grafting will be more appropriate in the present case.
Under peribulbar anesthesia, bulbar conjunctiva around staphyloma is excised apart. The membrane was removed and bleeding vessels are cauterized. Prolapsed uveal tissue was cut flushed using corneal scissors. No wound vitrectomy required. Defect was measured and a full-thickness allogenic scleral patch was sutured to the defect with 9-0 nylon suture. Recessed conjunctiva brought forward to cover the graft. The anterior chamber (AC) volume was restored with normal saline. Post operatively topical moxifloxacin (0.5%), carboxymethyle cellulose (1%,) prednisolone acetate (1%) drops each was prescribed 4 times a day to continue upto two weeks. On follow up the scleral patch graft was well apposed with normal cornea and other intraocular finding [Figure 2].
|Figure 2: Appearance after excision and scleral patch grafting with conjunctival covering|
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Surgical scleral wounds are usually prone to dehiscence with blunt trauma, which may occur even after 20 years of original cataract surgery, but our case has no history of trauma. In poor wound strength, even with normal IOP, uveal tissues may prolapse slowly as previously described by Mattice in 1913.
Management of anterior staphyloma extends from diathermy, excision and suturing of gaping edges, keratoplasty, scleral patch graft for salvageable eye to evisceration, or enucleation in nonsalvageable cases.
In our case, the mass was approximately 9 mm in height, so surgical excision with scleral patch grafting gave good tectonic support and regular ocular surface with improved vision due to reduction of high cylinder value from preoperative −2 DS/+9 DC at 175° with Best Corrected Visual Acuity (BCVA) 6/60 to postoperative 6/9 with −2 DS/−1.5 DC at 60°.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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Mattice AF. On the pathogenesis of scleral staphyloma. Arch Ophth 1913;42:612.
Vail D. Scleral staphyloma and retinal detachment. Trans Am Ophthalmol Soc 1948;46:58-72.
[Figure 1], [Figure 2]