Indian Journal of Ophthalmology (Jan 2023)
Every eye needs a best chance to see: Just give it
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. Video link: https://youtu.be/VoS8Irsh1yY
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