Year : 1979 | Volume
: 27 | Issue : 4 | Page : 227--228
Scleral transplantation in scleral staphylomas caused by oculosporidiosis
General Hospital, Kerala, India
E T Kurtokose
General Hospital, Kerala
|How to cite this article:|
Kurtokose E T. Scleral transplantation in scleral staphylomas caused by oculosporidiosis.Indian J Ophthalmol 1979;27:227-228
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Kurtokose E T. Scleral transplantation in scleral staphylomas caused by oculosporidiosis. Indian J Ophthalmol [serial online] 1979 [cited 2020 Nov 26 ];27:227-228
Available from: https://www.ijo.in/text.asp?1979/27/4/227/32643
Oculosporidiosis is a local inflammatory condition normally taking the form of a polypoid growth composed of granulation tissue. This is due to a fungus known as rhinosporidium Seeberi. This fungus occuring in the eye has been named oculosporidiosis.
This article is designed to illustrate rare manifestation of this disease as scleral staphylomas and the method of managing them.
Usually the oculosporidium affects the palpebral conjunctiva or the lacrimal passage but when the infection is on the bulbar conjunctiva, the earliest manifestation is seen as a patch of congestion on the bulbar conjunctiva. On careful examination this patch may show the usual granular greryish white spots as seen in oculosporidium polypus. Untreated this path of conjunctiva increases in thickness. The sclera underneath gradually thins out and perforates resulting in a scleral staphyloma of gradually increasing size [Figure 1],[Figure 2] which if untreated bursts resulting in the loss of the eye ball. The base of these staphylomas are generally circular.
This shift in position of the eye ball being of a very gradual development does not usually produce diplopia. Even loss of vision is very minimal compared to the size of the staphyloma.
Usually bleeding and appearance of a polypus are the earliest manifestation of an oculosporidium infection. But often both these are absent when the infection is on the bulbar conjunctiva because the affected area is pressed over by the lids there is no tendency for bleeding. Pain is seldom complained of by the patient. Loss of vision is minimal.
Treatment (Scleral Transplantation)
This paper is based mainly on my experience of scleral transplantations in cases of solitary scleral staphylomas, I had during the past five years. Even in places where oculosporidosis (Rhinosporidium of the eye) is prevalent the scleral staphylomas are relatively rare. The total number of cases I had during the past five year are only ten. All these cases were in cases of proved oculosporidiosis. They either gave history of recurrent oculosporidum polypus in the conjunctiva or had oculosporidiosis in the conjunctiva covering the staphyloma, which is proved by the histopathological examination. By experience it is found that scleral transplantation is the most satisfactory method of repairing these scleral staphylomas.
Materials and Methods
Excision of the affected conjunctiva along with a little of the surrounding healthy portion followed by cautery with 2% silver nitrate is a must in all cases. The donor material for sclera of donor eyes used for corneal transplantation could be used for the purpose, either fresh or after preserving in glycerine. The donor sclera is to be cut 2 mm larger in diameter than that of the area at the base of the staphylomas i.e. the deficiency or hole in the sclera causing the staphyloma. Often this deficiency or hole will be much smaller compared to the size of the staphyloma itself. Ordinary corneal trephine of appropriate size could be used to cut out the sclera from the donor eye. If the thickness of the donor sclera is found to be more, a part of its thickness can be sliced of or a thinner portion from the anterior aspect of the donor eye can be cut out. Adherant uveal tissue if any has to be properly removed from the cut out sclera.
The staphyloma is reduced to the maximum possible extend by paracentesis and by pressure on the surface of the staphyloma.
After removing the stillet of the corneal trephine of appropriate size a mark is made on the receipient sclera with the trephine. Keeping the herniated portion of the staphyloma inside the trephine. This mark is made about 0.2 mm deep by one or two careful rotation of the trephine giving moderate pressure. This should not be difficult for any ophthalmic surgeon with a certain amount of experience in handling the trephine. The donor sclera cut out by the same trephine is stitched on to the scleral cut made on the receipient, starting at any convenient position. After anchoring to one place the donor sclera is pulled over the staphyloma and reducing the same' by letting out fluid from the anterior chamber. By the time the sclera is stitched alround, the staphyloma gets reduced to such an extent that the transplanted sclera will be in flush with the surface of the receipient sclera. 8/0 virgin silk is found very satisfactory for suturing the sclera, in my cases.
Afier the donor sclera is stitched all round, the dissected conjunctiva is brought over it and the wound closed with 6/0 black silk which can be removed after a week.
In smaller staphylomas it may not be necessary to let out the aqueous from the anterior chamber. Only a surface coagulation will alone reduce the staphyloma to enable the stitching of the donor sclera over the staphyloma.
Q. (Dr. Asutosh Sarkar, Calcutta) How many cases you have operated? Was there any case of scleral necrosis?
A. (Dr. E.T. Kuriakose, I have done scleral transplantation in 7 out of 10 cases I have seen. Q. (Dr. Murthy) Was there any case of recurrence?
A. (Dr. Kuriakose) No.