Copyright 2001 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.2001
A 20-YEAR-OLD woman had sudden painless diminution of vision in the
right eye of 20 days' duration. She had noticed a spontaneously disappearing
blister in the same eye on waking from sleep and was aware of a hearing deficit
from the left ear. Her best-corrected Snellen visual acuity at initial examination
was 6/24 OD and 6/6 OS. The left eye was normal. Slitlamp examination of the
right eye revealed minimal cellular inflammation in the anterior chamber,
posterior subcapsular cataract, and intraocular pressure of 4 mm Hg with applanation
tonometer. The fundus examination showed hypotonic retinopathy and a choroidal
coloboma just temporal to the major vascular arcades (Figure 1). Interestingly, a fistula could be seen in the coloboma,
which appeared to open and close on eye movements. B-scan ultrasonography
also showed an area of choroidal excavation temporally with a communication
into the orbit and adjoining hypoechoic area, corresponding to fluid collection
from the leaking fistula (Figure 2).
Magnetic resonance imaging of the head and orbit confirmed the presence of
a posterior bulbar fistula of the right eye and also incidentally detected
acoustic schwannoma of the left eighth nerve (Figure 3). The patient underwent repair of the ocular fistula with n-butyl cyanoacrylate glue (Nectacryl; Nectar Laboratories
Limited, Hyderabad, India) and glycerine-preserved scleral graft. Intraoperatively,
a 7 × 7-mm area of extreme scleral thinning that corresponded to the
site of choroidal coloboma and had abnormal adhesions with the lateral rectus
muscle was identified. A small fistula was noted 5 mm from the anterior edge
of the scleral thinning (Figure 4).
Postoperatively, the patient had visual acuity of 6/9, intraocular pressure
of 14 mm Hg, resolution of the inflammatory reaction, closure of the fistula,
and disappearance of hypotonic retinopathy (Figure 5).
Gupta A, Narang S, Gupta V, Sharma A, Pandav SS, Singh P. Successful Closure of Spontaneous Scleral Fistula in Retinochoroidal Coloboma. Arch Ophthalmol. 2001;119(8):1220-1221. doi:10.1001/archopht.119.8.1220