Abstract

P 296

Surgical treatment of a perforated scleral staphyloma in Wegener's granulomatosis

Regine Augsten1, Ulrich Voigt1, Peter Oelzner2, Ekkehart Königsdörffer1
1Klinik für Augenheilkunde, 2Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena

Objective
Wegener´s granulomatosis is a focal granulomatous necrotizing chronic angiitis. In about 50% of patients with Wegener´s granulomatosis, ophthalmic diseases are involved (for instance necrotizing ulcers of the conjunctiva, sclera and of the corneal sclera, iritis, iridozyclitis, orbital infiltration with exophthalmus and impairments of the orbital nerves and the optic nerve).
Methods
The case of a 53-year-old patient with a necrotizing scleritis in Wegener´s granulomatosis is reported. The disease was known for seven years. The systemic immunosuppressive medication was initiated with mycophenolatmofetile (2 x 1000 mg) and prednisolone (7 mg). Using this therapy, local a conjunctival covering scleral staphyloma with slow progress was observed throughout several years, and systemic an arteritis and a chronic renal insufficiency were evident.
Results
The patient had developed a perforated scleral staphyloma in 2008. The corrected visual acuity was 0.2, and the intraocular pressure amounted to 4 mm Hg. Because of a circular bulky choroidal amotio, there was a risk of blindness and enucleation. The operative therapy was performed by removing conjunctival rests and covering the prolapse (size 10 x 11 mm) with fascia lata (size 12 x 13 mm). Postoperatively, the staphyloma was covered, the visual acuity amounted to 0.8 and the choroidal amotio was no longer evident. The findings are stable for one year.
Conclusions
In perforated scleral staphyloma, covering with fasciata lata is a very effective procedure. Supplementary, in cooperation with a rheumatologist an immunosuppressive therapy lasting a long period is necessary.

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