Diğer Yönlerden Normal Olan Bir Gözde Çift Konjenital Ön Skleral Stafilom

1. 1Gulhane Military Medical Academy, Medical School, Department Of Ophthalmology, Ankara, Turkey

Sorumlu Yazar: Mostly, we encounter congenital anterior staphylomas with other ocular abnormalities causing severe functional disturbance in a disfigured eye, and reconstruction of a satisfactory vision stands as a big challenge for caring ophthalmologists.6 To our knowledge, isolated congenital form of anterior staphyloma is quite rare. The pathogenesis still remains unclear, but it is certain that there is a scleral defect, allowing uveal tissue to protrude through the opening.3 The data obtained from histopathologic and electron microscopic studies suggest that this weakness on the wall occurs during embryogenesis.7 Furthermore, it is postulated that lack of mesodermal differentiation or intrauterine keratitis (either blood-borne or trans-amniotic) may be the causative factors.8,9 From this point of view, potency of causative agent and the time of insult may be the factors that determine the extension of ocular involvement. Currently, there is no standard classification system for congenital anterior staphyloma regarding severity of the disease. In our case, except for these two black spots, ophthalmologic examination was normal. However, we had no explanation for the possible insulting factor and mild form of the pathology. Literature review revealed only one similar case, but staphyloma was single, and located 6 mm away from the limbus.3 Though the diagnosis is clear in most cases, congenital anterior scleral staphyloma must be differentiated from lesions such as conjunctival nevus or melanoma, foreign body, and extraocular extension of ciliary body melanoma.1 It can be differentiated from such lesions simply by transillumination. But ultrasound biomicroscopy presents detailed data to help diagnosing in suspected cases. In our case, ultrasound biomicroscopic findings confirmed the anterior scleral staphyloma. Though follow-up was not adequate enough to reach a conclusion regarding progression, we did not observe any change in the morphology and recommended avoiding any ocular trauma and wearing protective eyeglasses. In conclusion, anterior scleral staphyloma can be congenital or acquired and also can be more than one. Ultrasound biomicroscopy and transmission of light with transillumination can help to differentiate anterior scleral staphyloma from pigmented conjunctival tumors and extraocular extension of ciliary body melanoma. Protective eyeglasses should be recommended for the patients with scleral staphyloma. Address for Correspondence/Yazisma Adresi: Murat Küçükevcilioglu MD, Gulhane Military Medical Academy, Medical School, Department of Ophthalmology, Ankara, Turkey Phone.: +90 312 304 58 72 E-mail: mkucukevcilioglu@gata.edu.tr Received/Gelis Tarihi: 17.06.2012 Accepted/Kabul Tarihi: 13.09.2012