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.

Eyelid and scleral thermal injury following phacoemulsification in silicone oil: a case report.

BACKGROUND: Phacoemulsification has been the mainstay method for extracapsular cataract extraction surgery in the anterior segment; for cases of posterior drop of lens fragments into the vitreous, a posterior segment phacoemulsification instrument (fragmatome; Alcon, Inc., Fort Worth, TX) can be employed to remove the dislocated lens materials. Studies have reported on thermal injury to the cornea during phacmoemulsification of the anterior segment. However, few studies have investigated thermal burn in the simultaneous sclera and eyelid induced by the fragmatome. Currently, there is no reports and lack of optimal strategy for the management of nucleus drop in a vitreous cavity filled with silicon oil. CASE PRESENTATION: We present the case of a 53-year-old male patient with a thermal burn wound on the upper eyelid and sclera following phacoemulsification for a dropped lens in a silicone oil-filled vitreous. We further designed an experiment to verify our hypothesis that thermal injury could be induced by the high temperature of the metal tip during phacoemulsification in silicone oil. In our experiment, during 420 s of continuous ultrasonic wave, the temperature of the fragmatome tip in the balanced salt solution (BSS) increased from 22.0 to 24.0 ºC, while the temperature of the fragmatome tip in the silicone oil group increased from 22.0 to 43.0 ºC. CONCLUSIONS: The temperature of the fragmatome tip increased significantly in silicone oil compared to BSS in the experiment. Thus, physicians should be aware of possible thermal complications when using fragmatome in eyes filled with silicone oil.

Anterior staphyloma repair following trauma and surgery - A retrospective review of techniques and outcomes over 25 years.

Purpose: To review surgical options, techniques, and outcomes of anterior staphyloma repair done following trauma and surgery. Methods: This was a retrospective case study of patients who underwent staphyloma repair with scleral or tibial periosteal patch grafts following trauma and surgery with a minimum follow-up of 3 months postoperatively. Preoperative risk factors, choice of graft materials, surgical details, and outcomes in terms of graft uptake and tectonic integrity were analyzed. Results: Seventeen eyes of 17 patients underwent successful staphyloma repair (scleral 15, tibial periosteal two). Mean follow-up was 47.1 months (3-159 months). Postoperative intraocular pressure rise noted in four eyes was controlled medically or surgically. Three patients underwent successful repeat patch grafting (graft melt one and recurrent ectasia two). Tectonic integrity of the eyeball was restored and maintained in all patients at the final follow-up. Conclusion: Comprehensive evaluation of the risk factors, control of ocular comorbid conditions, and early and meticulous surgery can optimize results.

Intercalary staphyloma after strabismus surgery in a patient with Marfan syndrome: A case report.

RATIONALE: A few cases of intercalary staphyloma have been reported in patients with Marfan syndrome, but we believe that this is the first case of intercalary staphyloma in Marfan syndrome developing after strabismus surgery. PATIENT CONCERNS: A 9-year-old girl diagnosed with Marfan syndrome visited a strabismus clinic for treatment of esotropia. Both eyes were aphakic and had 60 prism diopter esotropia at distance and 55 prism diopter esotropia at near. There were no corneal, conjunctival, or scleral abnormalities. Six millimeters of recession was performed on both medial rectus muscles via an inferonasal fornix approach under general anesthesia. 5 days after surgery, a dark gray protruding lesion was observed on the upper nasal side of the left eye. DIAGNOSES: Intraocular ultrasonography showed no bleeding, retinal detachment, or other abnormal findings. Computed tomography showed a conical protrusion of the scleral wall which was diagnosed as intercalary staphyloma. INTERVENTIONS: To reduce risk of progression of the staphyloma in the left eye and to reduce risk of development of a new staphyloma, intraocular pressure lowering eye drops were administered. OUTCOMES: We just observed it without any intervention except the intraocular pressures lowering eye drops. It remained stable for 12 months. LESSONS: Clinicians need to be alert to the possibility of this serious complication in Marfan syndrome patients after minor surgical trauma, which can occur during uneventful strabismus surgery.

Influence of graft vascularization on graft survival following homologous limbo-keratoplasty.

PURPOSE: Limbo-keratoplasty enables visual improvement and limbal stem cell transplantation at the same. During follow-up, most grafts show vascularization of the limbus. However, it is unclear whether vascularization is harmful due to immunologic effects or helpful to nourish the limbal stem cells and is therefore necessary for a clear graft. The aim of our study is to analyze the influence of graft vascularization on graft survival following homologous limbo-keratoplasty. METHODS: In this retrospective study, we assessed all consecutive limbo-keratoplasties performed in our hospital. All eyes with suitable photo-documentation were included and divided into two groups (limbal stem cell deficiency and corneal dystrophy). We categorized the grade of vascularization (0, 1, 2, 3, 3b) and analyzed clear graft survival, recurrence of the underlying disease and the endothelial cell density (ECD) with regard to the reason for the graft. Event rates were estimated with the Kaplan-Meier method. RESULTS: A total of 79 eyes with limbal stem cell deficiency and 15 with corneal dystrophies were analyzed. A high degree of graft vascularization had a tendency for better graft survival in limbal stem cell deficiency, whereas in corneal dystrophies, grafts with no vascularization had preferable outcomes. Recurrence-free graft survival was only seen in grade 1 and 3 vascularization in corneal dystrophies. CONCLUSION: Vascularization of the limbus seems to have an impact on the long-term outcome of limbo-keratoplasty. The effect seems to be favorable in limbal stem cell deficiency and on recurrence rates in corneal dystrophies. However, the latter might be overshadowed by an unfavorable immunologic effect in corneal dystrophies where the baseline immunologic risk profile is commonly more favorable than in limbal stem cell deficiency.

Tarsoconjunctival flap in scleral necrosis: report of three cases / Retalho tarsoconjuntival em necrose escleral: relato de três casos

ABSTRACT To report a series of three cases (four eyes) of scleral necrosis after pterygium excision, in which the tarsoconjunctival flap technique was used as treatment. Three patients who progressed to scleral necrosis after surgical pterygium excision were selected. The first patient underwent excision using the bare sclera technique and developed scleral thinning in the immediate postoperative period. The second and third patients received beta irradiation and had late onset scleral necrosis. The tarsoconjunctival flap technique was performed by the same surgeon. Recovery was satisfactory from both anatomical and functional perspectives in all cases, and the technique was considered effective and safe. Although there are only few reports about this technique in the literature, it can be considered as a good alternative to treat scleral necrosis.

RESUMO O objetivo deste estudo foi relatar uma série de três casos (quatro olhos) de necrose escleral pós-exérese de pterígio, em que se utilizou como tratamento a técnica de retalho tarsoconjuntival. Foram selecionados três pacientes que evoluíram para necrose escleral após tratamento cirúrgico de exérese de pterígio: o primeiro caso após técnica de esclera nua, com evolução para afinamento escleral no pós-operatório imediato; o segundo e o terceiro fizeram uso de betaterapia e apresentaram necrose escleral tardiamente. A técnica de recobrimento tarsoconjuntival foi executada pelo mesmo cirurgião. A recuperação foi satisfatória em todos os casos, do ponto de vista anatômico e funcional, sendo eficiente e segura. Apesar das escassas menções na literatura, essa técnica pode ser considerada uma boa alternativa para tratamento da necrose escleral.

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.

Surgical and Immunohistochemical Outcomes of Scleral Reconstruction with Autogenic, Allogenic and Xenogenic Grafts: An Experimental Rabbit Model.

Purpose: Choukroun's platelet-rich fibrin (PRF), a second-generation platelet concentrate, has unique morphological and chemical features and may be considered as a scaffold for scleral reinforcement and regeneration. The purpose of this study was to compare the use of xenogenic human-derived amniotic membrane (HAM), allogenic sclera, and autogenic PRF in rabbit lamellar scleral defect model with respect to both anatomical and immunohistochemical improvement. Methods: A total of 45 adult New Zealand rabbits were randomized into five groups: normal control; without surgical procedure, negative control; scleral defect model (SDM), xenogenic HAM; SDM+HAM graft, allogenic sclera; SDM+allogenic sclera graft, autogenic PRF; SDM+autogenic PRF graft. Clinical findings, Hematoxylin&Eozin (HE), Masson Trichrome, Verhoeff Acid Fuchsin, Transforming Growth Factor ß Receptor 1, Fibroblast Growth Factor, Bone Morphogenetic Protein 2, collagen type 1, aggrecan, and Matrix Metalloproteinase 2 were evaluated. Results: Ocular surface inflammation was significantly lower in normal control and autogenic PRF groups (p < .001). Graft was avascular and not integrated to scleral wound area in 25% rabbits of allogenic sclera group (p = .02), was out of the scleral wound in 33.3% rabbits of xenogenic HAM group (p > .05), all the grafts were at the normal location and viable in autogenic PRF group. The inflammation and vascularization in autogenic PRF group was significantly lower than negative control and xenogenic HAM groups in HE (p < .001). The collagen score of negative control and xenogenic HAM groups were significantly lower than normal control (p < .001) and autogenic PRF (p < .001) groups. There were insignificant differences between allogenic sclera and autogenic PRF groups (p > .05). For immunohistochemistry, the closest values to normal control group were detected in autogenic PRF group for all immunomarkers. Conclusion: Autogenic PRF showed superior features via its excellent anatomical and chemical composition for scleral regeneration when compared to single-layered xenogenic HAM and allogenic sclera grafts.

A 10-year review of histopathological findings of enucleated eyes from a tertiary-care center, Pakistan.

OBJECTIVE: To determine the histopathology of enucleated eye specimens. METHODS: The 10-year inventory was conducted at Aga Khan University Hospital, Karachi, and comprised all histopathology reports of enucleated eye specimens received from January 2007 to December 2016 by the Section of Histopathology, Department of Pathology. SPSS 19 was used for data analysis. RESULTS: A total of 232 ocular tissue specimens from 231 patients were evaluated. Ocular tumours were the most common histopathological diagnosis 186(80%). Among tumours, retinoblastoma was the most common 137(59%) followed by malignant melanoma 31(13%) and squamous cell carcinoma 15(6.5%). Overall, 16(6.9%) specimens had degenerative changes secondary to different ocular disorders. Staphyloma and Coat's disease was diagnosed in 3(1.3%) cases each. In 4(1.7%) cases, there was no formal diagnosis. CONCLUSIONS: Early identification of tumours may allow for conservative management and limit the need for enucleations.

[Excision and tectonic covering of a vascular leiomyoma of the ciliary body with large anterior staphyloma using scleral patch graft]. / Exzision und tektonische Deckung eines vaskulären Leiomyoms des Ziliarkörpers mit großem anteriorem Staphylom mittels Sklerapatch.

Benign tumors of the ciliary body are rare and may potentially be confused with uveal melanoma in clinical routine. Clinical findings rarely allow for safe differentiation. Hence primary excisions are frequent. We report the case of a patient with a benign ciliary tumor, which was observed over a total of 13 years and eventually underwent a local tumor resection.

Amniotic membrane, clinical applications and tissue engineering. Review of its ophthalmic use. / Membrana amniótica, aplicaciones clínicas e ingeniería tisular. Revisión de su uso oftalmológico.

The use of amniotic membrane in ophthalmology has been increasing in recent years due to its multiple biological and tectonic properties, improvement in the process of obtaining, ease of use, and advancement in tissue engineering. The amniotic membrane has become one of the main adjuvant treatments, in ophthalmic surgery as well as in other medical-surgical specialties. The development of tissue engineering has allowed it to be used, not only in its classic form, but also by the use of drops and other presentations. The different steps prior to its use (preparation and conservation), the different surgical techniques, and their main clinical applications are described throughout the article.

Panophthalmitis associated with scleral necrosis in dengue hemorrhagic fever.

Dengue is a mosquito-borne flavivirus disease affecting humans. The Aedes aegypti mosquito spreads it. Ophthalmic manifestations of dengue range from subconjunctival hemorrhage to optic neuropathy. Panophthalmitis in dengue fever is a rare finding. We report a case of a 22-year-old male having dengue fever, who presented with pain, redness, swelling and loss of vision in his right eye. He was diagnosed as panophthalmitis with subretinal hemorrhage and required right eye evisceration.

[Local, regional and systemic dissemination of choroidal melanoma : Clinical and pathological correlation from 2 cases]. / Dissémination locorégionale et systémique du mélanome choroïdien : corrélation anatomoclinique à partir de 2 cas.

PURPOSE: To describe didactically the local, regional and systemic spread of choroidal melanoma. PATIENTS AND METHODS: Two patients who had undergone primary enucleation for the management of choroidal melanoma in 2018 at the University Hospital of Nice were included. Extrascleral extension and invasion of the vortex veins were evaluated, as well as synchronous and metachronous metastases, based on our database. RESULTS: Patient 1 was diagnosed with large choroidal melanoma with partial scleral invasion and vortex vein involvement. Cytogenetic analysis demonstrated a loss of chromosome 3, and a gain of chromosome 8q. Systemic work-up was unremarkable. Patient 2 was diagnosed with a large choroidal melanoma with extrascleral extension and vortex vein involvement. Cytogenetic analysis demonstrated a loss of chromosome 3 and a gain of chromosome 8q. Systemic work-up revealed several liver metastases. A total of 1762 patients were included in our database. Eighty-five patients (4.8 %) and 46 patients (2.6 %) experienced vortex vein invasion and extrascleral extension respectively. Patients with vortex vein invasion were diagnosed with synchronous and metachronous liver metastases in 1.2 % and 18.8 % respectively. Patients with extrascleral extension had synchronous and metachronous liver metastases in 6.5 % and 30.4 % respectively. The mean follow-up was 49.4 months (1-180). CONCLUSION: Extrascleral extension and vortex vein invasion illustrate the local, regional and systemic spread of choroidal melanoma. The latter are often associated with genetically aggressive tumours associated with high metastatic risk.

Transplantation of autologous perichondrium with amniotic membrane for progressive scleral necrosis.

PURPOSE: Scleral necrosis with severe ischemia is refractory to conventional treatment because of avascular progressive necrosis. We assessed the therapeutic efficacy and safety of autologous perichondrium transplantation in patients with progressive scleral necrosis (PSN) and analyzed the clinical effects. METHODS: This study was a prospective, interventional, and noncomparative case series. Reconstructive surgery using autologous perichondrium and amniotic membrane (AM) was performed in patients with PSN who showed progressive ischemic scleral melting with impending perforation state and/or broad avascular area larger than 10 mm in diameter. The primary outcome was restoration of scleral integrity with healthy vascularized epithelium over the graft at six months after surgery. The secondary outcome was complication rate associated with autologous perichondrium graft use. RESULTS: Eighteen eyes of 14 patients underwent reconstructive surgery using autologous perichondrium patch and AM grafts. Observations indicated the graft provided the eyeball with successful structural integrity in 17 out of the 18 cases (94.4%) at six months after surgery. One eye showed a small scleral defect due to wound dehiscence at four month after the surgery. Additional surgery using perichondrium and AM stabilized the eye. The scleral necrosis healed completely after perichondrium and AM transplantation, even in cases with full-thickness scleral defect. The scleral integrity was maintained until the last follow-up session. There were no serious complications of endophthalmitis or graft infection. CONCLUSIONS: Reconstructive surgery using autologous perichondrium and AM is an effective method for restoration of scleral integrity and vascularization of the episclera and conjunctiva in eyes with PSN. Therefore, autologous perichondrium can be considered as an appropriate new biologic tissue for PSN.

Progressive Intrascleral Epithelial Cyst With Intracorneal Extension.

The authors report a case of primary sclerolimbal cyst with corneal extension in a 3-year-old boy. The cyst enlarged and dissected into the cornea over time. Surgical excision with tectonic allograft was performed. Preoperative, intraoperative, and postoperative anterior segment findings were shown, and results from histologic and cytologic assays were presented. [J Pediatr Ophthalmol Strabismus. 2019;56:e20-e23.].

Conjunctival Flap with Biodegradable Collagen Matrix Implantation for the Treatment of Scleromalacia after Periocular Surgery.

Purpose: To report a new surgical procedure using biodegradable collagen matrix (Ologen) implantation with conjunctival flap for reconstruction of scleromalacia after periocular surgery. Methods: A total of 26 areas of 25 eyes in 25 patients were included. We divided all eyes according to the preoperative extent of calcified plaque or scleral defect as follows: small, large, and large and severe. Morphologic outcomes were graded from 0 to 7, with higher scores indicating worse cosmetic outcomes. Results: Mean follow-up period was 8.3 ± 5.6 months. No eyes showed recurrence or specific complications related to Ologen such as implant extrusion or allergic reaction. Minor complications such as flap vessel engorgement and flap hypertrophy were easily treated. Mean morphologic outcome scores were 1.8, 2.4, and 5.3 in groups 1, 2, and 3, respectively. Discussion: The combined surgery may be an effective and safe procedure for the treatment of scleromalacia after periocular surgeries.

Epibulbar osseous choristoma: a photo essay case report.

PURPOSE: To present the pre-, per- and postoperative features of epibulbar osseous choristoma. METHODS: Case description including intraoperative imaging and histopathology. RESULTS: A 32-year-old male patient presented with a lesion on his right eye, suggestive of an epibulbar dermolipoma. Excision of bony lesion was performed and revealed epibulbar osseous choristoma. CONCLUSIONS: Epibulbar osseous choristoma is a rare and benign condition which can present with features similar to dermolipoma.