ABSTRACT
Background: Anterior staphyloma is defined as a localized defect in the anterior eye wall with protrusion of the uveal tissue due to alterations in scleral thickness and structure. The causes could be congenital, trauma, or following infection. Surgical options include staphylectomy with graft (corneal/ corneoscleral), biosynthetic graft, enucleation or evisceration in a painful blind eye). Purpose: To demonstrate staphylectomy with careful preservation of ocular structures followed by optical keratoplasty in a single setting. Synopsis: A 39?year?old Asian Indian lady presented with complaints of blurring of vision and whitish opacity in both eyes since childhood, associated with progressive enlargement and protrusion of the black part of the left eye with severe pain at the time of presentation. Her clinical examination revealed leucomatous corneal opacity in both the eyes and anterior staphyloma and keratinization in the left eye. Visual acuity was counting fingers close to face in the right eye and hand movements close to face in the left eye with projection of rays being accurate in both eyes. Ultrasound B scan showed posterior staphyloma in the right eye with sub?Tenon’s fluid and increased retinochoroidal thickness. The left eye posterior segment with B scan was normal. The available surgical options were evisceration with secondary orbital implant and ocular prosthesis or staphylectomy with corneal transplantation. To provide the best option for the patient in her eye with better visual potential, staphylectomy with corneal transplantation was done. Highlights: Painful blind eye is usually dealt with evisceration. This video demonstrates the technique of staphylectomy with corneal graft and restoration of structural integrity. Evisceration is a destructive procedure that involves removal of the intraocular contents. The patient will have to deal with the hassles of prosthesis maintenance and stigma of the artificial eye
ABSTRACT
Background: Anterior staphyloma is defined as a localized defect in the anterior eye wall with protrusion of the uveal tissue due to alterations in scleral thickness and structure. The causes could be congenital, trauma, or following infection. Surgical options include staphylectomy with graft (corneal/ corneoscleral), biosynthetic graft, enucleation or evisceration in a painful blind eye). Purpose: To demonstrate staphylectomy with careful preservation of ocular structures followed by optical keratoplasty in a single setting. Synopsis: A 39?year?old Asian Indian lady presented with complaints of blurring of vision and whitish opacity in both eyes since childhood, associated with progressive enlargement and protrusion of the black part of the left eye with severe pain at the time of presentation. Her clinical examination revealed leucomatous corneal opacity in both the eyes and anterior staphyloma and keratinization in the left eye. Visual acuity was counting fingers close to face in the right eye and hand movements close to face in the left eye with projection of rays being accurate in both eyes. Ultrasound B scan showed posterior staphyloma in the right eye with sub?Tenon’s fluid and increased retinochoroidal thickness. The left eye posterior segment with B scan was normal. The available surgical options were evisceration with secondary orbital implant and ocular prosthesis or staphylectomy with corneal transplantation. To provide the best option for the patient in her eye with better visual potential, staphylectomy with corneal transplantation was done. Highlights: Painful blind eye is usually dealt with evisceration. This video demonstrates the technique of staphylectomy with corneal graft and restoration of structural integrity. Evisceration is a destructive procedure that involves removal of the intraocular contents. The patient will have to deal with the hassles of prosthesis maintenance and stigma of the artificial eye.
ABSTRACT
PURPOSE: To investigate the clinical outcome of glaucoma surgery performed in patients with painful blind glaucomatous eyes. METHODS: A single-center, retrospective, interventional case series was performed by reviewing the medical records of 74 glaucoma patients (74 eyes) who underwent Ahmed glaucoma valve (AGV) implantation or trabeculectomy for painful blind eyes from October 2004 to January 2014. Blindness was defined as visual acuity less than hand motion at the time of surgery. Preoperative and postoperative intraocular pressure (IOP), number of anti-glaucoma medications, and presence of pain were compared in the patients grouped according to the type of glaucoma surgery. The glaucoma type, history of previous glaucoma surgery and postoperative failure/complications were also evaluated. RESULTS: AGV implantation was performed in 42 eyes (56.8%) of 42 patients, and trabeculectomy was performed in 32 eyes (43.2%) of 32 patients. The average IOP decreased from 41.73 +/- 11.77 mm Hg before surgery to 14.29 +/- 9.34 mm Hg at five years after the surgery (p < 0.001, paired t-test). The IOP was not significantly different between the groups at any follow-up time point (p = 0.949, linear mixed model). Overall, three patients (4.1%) still experienced eye pain after surgery, IOP greater than 30 mm Hg was observed in eight eyes (10.8%), and additional surgery was required in 11 eyes (14.9%). Evisceration was required in only two eyes (2.7%). Sympathetic ophthalmia was not found in any patient during the follow-up period. CONCLUSIONS: Glaucoma surgery including AGV implantation/trabeculectomy was effective and safe even for painful blind eyes. The procedure may be considered as an alternative to enucleation as an initial surgical option for painful blind glaucomatous eyes.