Staphyloma is a pathological protrusion of the posterior surface of the sclera. Clinically manifested by a decrease in visual acuity and narrowing of the visual field. Diffuse atrophy of the retinal pigment epithelium is detected on the fundus, the presence of peripheral vitreochorioretinal dystrophy or retinal traction is possible. For diagnosis, an external examination is used, visual acuity and the nature of vision are examined, tonometry and biomicroscopy are performed. Of the additional methods, ultrasound of the eyeball, computer perimetry, electroretinography are used. Treatment of staphyloma is conservative (drugs and physiotherapy to improve blood supply to the retina, strengthen the sclera and relax the accommodation of the eye) and surgical (aimed at strengthening the posterior surface of the sclera).
ICD 10
H15.8 Other sclera lesions
General information
Staphyloma is a pronounced deformation of the sclera with pathological prolapse and elongation of the axis of the eye. Sclera staphyloma occurs with high-grade myopia. Myopia is the most common disease and the main cause of blindness in developed countries. In the USA, 15% of the population suffers from refractive errors, 3% of them have a complicated form with pronounced changes in the fundus. Myopic staphyloma develops at the age of 20 to 40 years. It is often accompanied by other pathological changes in the structure of the eye and is the cause of disability at a young working age. Rehabilitation of patients with high-grade myopia and prevention of complications are still important problems in modern ophthalmology.
Causes
The scleral membrane is an outer opaque capsule of the eyeball and contains in its structure cellular elements that are immersed in a basic substance consisting of glycosaminoglycans, protein, polysaccharide complexes. 70% of the sclera consists of collagen protein, its bundles – fibrils form a special plexus with elastic fibers. Thanks to this structure, the scleral membrane performs its main functions – maintaining the strength and elasticity of the eyeball. With the development of a high degree of myopia, the collagen fibers of the sclera are loosened. In the posterior pole, the number of proteases increases, which destroy adhesive bonds in elastic fibers and lead to the formation of staphyloma.
Symptoms of staphyloma
Clinically, staphyloma manifests itself with the development of complications in a patient with high-grade myopia. Most often there is a significant decrease in visual acuity, rapid fatigue, a feeling of heaviness in the eyes. There may be a narrowing of the field of vision in one eye. Upon examination, an ophthalmologist may detect extensive staphyloma on the fundus (a white focus of atrophy in the form of a ring at the posterior pole), diffuse atrophy of the pigment epithelium, “albinotic” color of the fundus, the presence of peripheral vitreochorioretinal dystrophy or traction. The lesion is more often bilateral. Complications of myopic staphyloma include the occurrence of retinal dystrophy, the formation of hemorrhagic detachment of the retina, destruction of the vitreous body, the development of cataracts, open-angle glaucoma.
Diagnostics
Diagnosis of staphyloma begins with the collection of anamnestic information. Then an ophthalmologist performs an external examination, examines visual acuity and the nature of vision, conducts tonometry. Biomicroscopy using a slit lamp is the main method of diagnosing staphyloma. It is mandatory to perform a study of refraction of the eye with the use of cycloplegia. Additional methods include ultrasound of the eye with measurement of the anterior-posterior axis and computer perimetry (to identify paracentral defects of the visual field). Optical coherence tomography is used to diagnose the condition of the macular region. Electroretinography helps to identify functional disorders in the retina and the vascular membrane of the eyeball.
Treatment of staphyloma
Treatment of myopic staphyloma is complex, includes both surgical and conservative techniques. The primary task of therapeutic measures is to reduce the progression of myopia. Conservative therapy of staphyloma includes the use of drugs that affect relaxation of accommodation, help strengthen the scleral membrane, improve hemodynamics of the eye, metabolic processes in the retina and vascular membranes of the eye and enhance visual functions.
With the development of hemorrhages in the retina, it is necessary to use hemostatic, resorbing and desensitizing agents. Physiotherapy treatment is also indicated. Electrophoresis, laser stimulation or magnetophoresis are prescribed. Rigid orthokeratological lenses can be used to reduce the rate of progression of myopia. Surgical treatment of staphyloma is aimed at preventing further stretching of the scleral membrane. Various techniques are used to strengthen the posterior pole of the eyeball.
Prognosis and prevention
The prognosis is often doubtful. Prevention of myopic staphyloma is aimed at reducing the progression of myopia. It includes measures to promote health and physical development in childhood and adolescence, to teach children and adults the rules of visual hygiene. It is necessary to organize high-quality lighting in schools and workplaces, monitor compliance with sleep and rest, limit the use of tablets and phones by children, and regularly visit an ophthalmologist for preventive examinations.