|Year : 1969 | Volume
| Issue : 2 | Page : 64-66
Congenital anterior staphyloma
DK Gupta, Hari Mohan, DK Sen
Department of Ophthalmology, Irwin Hospital, New Delhi, India
|Date of Web Publication||8-Jan-2008|
D K Gupta
Department of Ophthalmology, Irwin Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta D K, Mohan H, Sen D K. Congenital anterior staphyloma. Indian J Ophthalmol 1969;17:64-6
Congenital anterior staphyloma is quite a rare condition. PARSONS collected 15 cases from a record of over a period of 100 years. As noted by DUKE-ELDER - 17 case reports since then have been published. Recently 2 more cases have been reported from India (AGARWAL; GUPTA, PATNAIK AND AGARWAL). We are presenting herewith 2 more cases of congenital anterior staphyloma because of the rarity of the condition.
| Case reports|| |
Case No. 1 . B. K. Male Hindu child aged 3 years attended the ophthalmic O.P.D. Irwin Hospital, New Delhi on 2nd February, 1967 with the history of protruding blackish mass from the left eye since birth. There was no history of inflammation of the eyes.
The child was delivered normally. No history of fever, trauma, nutritional deficiencies or X-ray exposure during pregnancy could be elicited in the mother. There was no history of any such defect in the family.
General and systemic examination of the patient did not reveal anything significant.
Examination of the eyes:
Right eye was perfectly normal except for the presence of small nebulomacular corneal opacity near the imbus from 4 to 6 O'clock position [Figure - 1] The shape, diameter and surface of the cornea was normal. There was no other significant finding.
The left eye showed searching movements on covering the right eye and the cornea was bulging forwards between the lids [Figure - 1] The exposed portion of the conjunctiva was lusterless and thickened showing crescentic folds and was lightly pigmented. The corneoscleral junction could not be clearly defined. The cornea was opaque, thinned out and ecstatic. The surface was smooth and vascularised at the periphery. The iris was adherent to the back of the cornea. An irregular shallow anterior chamber could be made out in some quadrants. Other details could not be made out. Digitally the tension was felt to be normal.
The left eye was enucleated under general anaesthesia on 7th February, 1967 [Figure - 2]. The muscles were found to be normal.
Section showed much disorganization of cornea and iris. The regular corneal lamellae were replaced by irregularly laid fibrous tissue. Bowman's and Descemet's membranes were absent altogether. Whole of the iris was adherent to the back of the cornea and its stroma was much atrophied. The lens was shrunken and cataractous but occupied its normal position. The trabecular tissue and posterior segment of the globe were normal. No inflammatory cells were resent in any of the sections.
Case No. 2: SC aged 5 years Hindu, male child presented a similar picture of congenital anterior staphyloma affecting the right eye. The left eye was normal. The parents of the child noticed a protruding blackish mass from the right eye since birth. There was no relevant significant history of any disease in the mother during pregnancy.
On examination, the right eye was bulging forward between the lids [Figure - 3]. The exposed portion of the conjunctiva was dry and xerotic. The cornea was opaque and the surface was smooth. The iris was adherent to the back of cornea and an irregular shallow anterior chamber could be made out at few places. Other details could not be made out.
The right eye was enucleated and sent for histopathologic examination [Figure - 3],[Figure - 4]. Histological features were essentially the same as in the first case.
| Discussion|| |
Etiopathogenesis of congenital anterior staphyloma is a controversial subject. Many reports attribute this condition to be inflammatory in origin (Parsons, Runte, Clausen, Marchesani, but Collins and others thought that staphyloma was primarily due to developmental aberration when the failure of differentiation of waves of mesoderm resulted in adhesion of cornea to iris. The evidence on the whole points to an in intrauterine inflammation in most of the cases of congenital staphyloma (Blood borne or trans-amniotic) but it cannot be denied that a faulty differentiation of the anterior mesoderm might produce the same condition (Mann)
Probabilities are that two types of such congenital anterior staphyloma exist – one is of inflammatory origin and the other is due to developmental defect. The latter is, however, all the more rare.
In view of the fact completely absent inflammatory cells were completely absent in our specimen, the pathological process might be a primary mesodermal aberration. The small corneal opacity in the right eye was due to minimal mesodermal aberration on that side. Though a subclinical intrauterine infection like rubella is known to resemble such developmental anomalies, in such a case multiple defects should have been expected.
| Summary|| |
Two cases of congenital anterior staphyloma due to mesodermal aberration are presented.
| References|| |
AGARWAL, T. P. (1963): Orient A. Oph. 1,221.
CLAUSEN: Arch, Augenh, 91, 198 (1922) cited by Duke-Elder, S. (1964).
COLINS, E. T. (1913): Trans. Oph. Soc. U.K., XXXIII, 158, Cited by Duke-Elder (1964).
DUKE-ELDER, S. (1964): System of Ophthalmology, Vol.III (Part 2) p. 523-27. Henry Kimpton, London.
GUPTA, A K., PATNAIK, B., AND AGARWAL, L. P. (1965): Orient. A. Oph. 3, 105.
MANN, Ida (1957): Developmental abnormalities of the eyes", 2nd Edition. P. 347, 355. British Medical Association House, Tavistock, Square, London W.C.1.
MARCHESANI (1930): Arch, augenh., 103, 632. Cited by Duke-Elder, S. (1964).
PARSONS J. (1904): Trans, Oph. Soc. U.K. P. 47, Cited by Duke-Elder, S. (1964).
RUNTE (1903): Arch. Augenh, 48, 62. Cited by Duke-Elder, S. (1964).
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]