Marzo 2009
Spontaneous Scleral Perforation In Ocular Rosacea Ana Carolina Vieira MD1,2, Mark J Mannis MD2 1 Department of Ophthalmology, Federal University of São Paulo, Brazil 2 Department of Ophthalmology & Vision Science, University of California, Davis
No funding was received for this work.
Corresponding author: Mark J. Mannis MD, Professor and Chair, Department of Ophthalmology & Vision Science, University of California, Davis, 4860 Y St, Suite 2400, Sacramento, CA 95817 Voice: 916-734-6957 Fax: 916-703-5076 E-mail: mjmannis@ucdavis.edu
Figure 1 Small round scleral perforation with protruding vitreous in a patient with ocular rosacea.
Resumo Objetivo: Relatar um caso raro de perfuração escleral espontânea em paciente com rosácea ocular tratado cirurgicamente com enxerto escleral. Métodos: Relato de caso. Resultados: Paciente feminina, 52 anos, com diagnóstico prévio de rosácea ocular há 9 anos procurou atendimento oftalmológico apresentando perfuração escleral espontânea no olho esquerdo. Ao exame, notavase eritema facial e pápulas eritematosas. A biomicroscopia do olho esquerdo revelou disfunção meibomiana, hiperemia conjuntival, afinamento corneano periférico, neovascularização e depósitos lipídicos na região temporal da córnea. Na região temporal da esclera, observava-se área de perfuração escleral, medindo aproximadamente 1 mm de diâmetro, através da qual se percebia protrusão vítrea. A perfuração escleral foi tratada cirurgicamente com um enxerto homólogo de esclera fixado com cola de fibrina e 4 suturas com fio de mononylon 10-0. Um mês apos o procedimento cirúrgico, a acuidade visual corrigida era 20/25.
Conclusão: Esclerite pode ser uma complicação rara das formas graves de rosácea ocular. O enxerto escleral homólogo mostrou-se eficaz no tratamento da perfuração escleral secundária a rosácea ocular. Pacientes portadores de rosácea ocular e esclerite requerem tratamento sistêmico e acompanhamento frequente por um oftalmologista. Palavraschave: rosácea ocular, esclera, perfuração, enxerto homólogo.
asuring approximately 1 mm in diameter, with protruding vitreous was present. The scleral perforation was repaired with a homologous scleral patch graft sealed into position with fibrin glue and 4 sutures of 10-0 monofilament nylon. One month postoperatively, her best corrected visual acuity was 20/25.
Purpose: To report a rare case of spontaneous scleral perforation in a patient with ocular rosacea and its surgical management.
Conclusion: Scleritis can be a rare complication of severe ocular rosacea. A homologous scleral patch graft proved successful in treating this condition. Patients with ocular rosacea severe enough to induce scleritis require systemic therapy and close monitoring. Key words: ocular rosacea, sclera, perforation, homologous graft.
Methods: Case report.
Introduction
Results: A 52 year-old woman with a history of ocular rosacea diagnosed 9 years earlier presented with a spontaneous scleral perforation in the left eye. On examination, axial facial redness with erythematous papules was present. Slit lamp examination of the left eye revealed meibomian gland dysfunction, conjunctival injection, marked peripheral corneal thinning, neovascularization and lipid deposition in the cornea temporally. A discreet round scleral perforation temporal to the limbus me-
Rosacea is a chronic progressive cutaneous disorder that affects approximately 13 million Americans.1 It is characterized by persistent erythema, telangiectases, papules and pustules that involve primarily the convexities of the central face (cheeks, chin, nose and central forehead). If left untreated, it can be disfiguring and the ocular form has the potential to compromise vision.
Abstract
The etiology of the disease is still unknown. Many factors have been implicated in PAN-AMERICA : 149