From: Subject: Name of speciality Date: Mon, 4 Sep 2006 10:43:31 +0530 MIME-Version: 1.0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: file://C:\WINNT\Profiles\Administrator\Desktop\1sep\optha\anterior.htm X-MimeOLE: Produced By Microsoft MimeOLE V5.00.2314.1300 Name of = speciality

Name of speciality           =20 :           =20 Ophthalmology

Name of case=20            =20 :           =20 Anterior Staphyloma

Name of expert :           =20 Dr. Kamini L Audich

Name of Hospital           =20 :           =20 M & J Institute of=20 Ophthalmology, Ahmedabad

 

 

Definition

           =20 Staphyloma(Literal meaning : bunch of dark grapes)

 

Staphyloma is=20 a clinical condition of characterized by ecstatic cicatrix of outer = coats(cornea=20 or sciera or both) of the eye with an incarceration of the uveal = tissue.

 

Depending on the site affected = Staphyloma=20 can be calssified as

(i)       = Anterior

(ii)      = Intercalary

(iii)   =20 Ciliary

(iv)   =20 Equatorial

(v)    =20 Posterior

 

Anterior Staphyloma =96 involves=20 cornea:

           =20 The basic development is studied in detail by Fuchs.

The basic=20 underlying pathology is a weakening of the eye wall, which can be caused = by many=20 inflammatory or degenerative diseases involving these structures.

 

Most commonly=20 a raised intra ocular pressure accompanies the diseases causing the = weakening of=20 coat and both contribute to the development of the Staphyloma.

 

It can be congenital or = acquired.

 

Congenital: Hereditray =96 = few cases are=20 reported.

           =20         =20 Intrauterine

           =20         =20 Inflammation    =20            =20            =20 Maldevelopment

           &nbs= p;           =20            &nbs= p;           =20            &nbs= p;           =20

           &nbs= p;           =20            &nbs= p;           =20            =20            =20 No historical evidence of inflammation

           &nbs= p;           =20            &nbs= p;           =20            &nbs= p;           =20

There is=20 failure of migration of mesenchymal tissue that form the posterior = cornel=20 structure, iris & angle Increased IOP due to angle abnormality leads = to=20 corneal opacity plus thinning causing prominent buphthalmic enlargement = of=20 entire anterior segment.

 

 

 

Acquired  can be partial / total = depending on part=20 or whole of the cornea is affected.

 

Etio-Pathogenesis =96 Most = common cause=20 is sloughing corneal ulcer, keratomalacia due to Vit, A Def. or trauma. = It=20 perforates & heals with the formation of a pseudo cornea =96 by the=20 organization of exudates & laying down of fibrous tissue.

It is lined=20 internally by iris, externally by newly formed epithelium.

A.C.=20 becomes flat leading to secondary glaucoma.

Weak ant,=20 surface of eye cannot withstand raised IOP & protrudes outward = leading to=20 anterior Staphyloma.

 

The pathological=20 development:-

a.     = Earliest stages =96 Prolapsed Iris directly covered = by=20 epithelium.

b.     = Eventually proliferating epithelium fills all the = crevices=20 available to & usually becomes greatly thickened, sending numerous = down=20 growths into the tissue underneath.

c.      = Meantime an intense iritis sets in. The = incorporated uveal=20 tissue becomes packed with leukocytes, granulatation tissue forms = sometimes on=20 large masses on its surface.

d.     = This gradually develops into a fibrous scar merging = with=20 that derived from cornea binding the whole mass.

e.     = As time goes on iris stroma gradually atrophies = & is=20 replaced by fibrous tissue & pigment epithelium breaks down & = pigment=20 granules are taken up by leucocytes or travel into the epithelium or = become=20 embedded in the scar, where they remain sometimes for years, sometimes = =96=20 permanently. The thickness of the Staphyloma varies with the amount of = scar=20 tissue formed.

f.      =20 The pseudo cornea may be immensely thick or thin as = paper=20 when the epithelium grows directly over the prolapsed iris with the=20 interposition of a minimal amount of granulation tissue.

g.     = In this event the scqar tissue may not be strong = enough to=20 withstand the intraocular pressure so that an increasing bulging = results.

h.     = When it is thin the uveal pigment becomes more = obvious so=20 that depending on the thickness the color may vary from slate gray to a = deep=20 blue black and since great differences may occur in same Staphyloma =96 = bulging=20 dark areas may be separated by retracted fibrous bands =96 giving a = picture=20 justifying the name of =93a bunch of grapes=94.

i.      =20 Its extreme tenacity is readily demonstrable by the = ease=20 with which it dimpled when touched & vividness of the effect = produces by=20 transillumination.

 

D/D Ectasis &=20 Staphyoma:

     The = process=20 involves only outer coat & uveal tissue is not implicated =96 it is=20 ectasia.

     But if the = uveal tissue=20 is intimately affected so that it becomes fused with uter coat =96 it is = Staphyloma.

 

 

 

 

 

Signs and = Symptoms:

=A7        =20 Eventually the eyeball attains enormous size

=A7        =20 Causes pain due to raised tension

=A7        =20 Discomfort of exposure keratitis

=A7        =20 Blephrospasm due to unavailing attempts to close = stretched lids.

 

Clinical course &=20 Complications:

It is a progressive = lesion=20 causing further increase in IOP. As the bulge increases it involves the = tissues=20 of the eye in cumulative troubles.

a)      = Atrophy of uveal tissue

b)      = Irido dialysis

c)      = Luxation of lens

d)      = Desplacement or total protrusion of cornea

 

Glaucoma mainly in = anterior=20 Stapyloma is because of deformation of angle, which interferes with = fluid=20 traffic of the eye. It is basically a vicious circle initiated =96 in = which the=20 raised tension caused by Staphyloma augments the initial lesion.

 

Natrual termination = is rupture of=20 the globe & its eventual destruction by panophthalmitis.

 

Prevention

Inflammatory diseases = such as=20 corneal ulcer and keraomalacia form Vitamin A deficiency of rheumatoid = arthritis=20 should be promptly treated prevention of secondary glaucoma to prevent = the=20 formation of Staphyloma.

 

Treatment

Non-Surgical Treatment = presents =96=20 serious & often presssin problems & many times very = difficult.

(A)  = Medical=20 treatment of secondary glaucoma

(B)  Anti=20 inflammatory for repeated attacks of irritation

Surgical = Treatment

(A)  Small Staphyloma: Division pf = adherent=20 Iris; Isolation of incarcerated portion by iridectomy on either = side.

(B)  Large; Removal of Staphyloma = &=20 replacement by corneal graft.

(C)  Worst Cases: Enucleated & = replaced=20 with an implant depending on the extent of involvement or degree of = cosmetic=20 disfigurement.

(D)  Progressive: More remedial = measured are=20 required if there is a hope for vision. Older generations treated with = wide=20 basal iridectomy if possible & done in time may be effective in = preventing=20 the progress.