Mansour Ahmad M, Uwaydat Sami H, Hamam Rola, Salti Haytham I
Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.
Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Case Rep Ophthalmol. 2024 Apr 2;15(1):284-291. doi: 10.1159/000537829. eCollection 2024 Jan-Dec.
Nanophthalmos is characterized by a short axial length, a thick choroid, and a thick sclera. Unilateral symptomatic disc swelling in nanophthalmos presents both a diagnostic and a therapeutic challenge.
A healthy 59-year-old man reported a two-week-long abrupt vision reduction in his right eye. 20/100 best spectacle (+17.25 diopter) corrected visual acuity, unilateral widespread disc enlargement, central scotoma, and a slight color vision disruption without an afferent pupillary defect were among the positive findings in the right eye. Workup for neuro-ophthalmology was negative. Numerous consultations did not suggest any form of treatment for the patient. Review of the optical coherence tomography (OCT) indicated a small, crowded optic nerve head and substantial diffuse choroidal thickening with dome-shaped temporal peripapillary area with choroidal expansion. In addition to circumferential anterior four-quadrant 95%-deep sclerectomy from recti insertion to the vortices, radial nasal posterior sclerotomy reaching the optic nerve sheath was performed on the patient. After the procedure, 2 weeks later, the patient's vision returned, and it persisted until the 6-month follow-up. By OCT, the two eyes were comparable as far as disc contour and nerve fiber layer thickness.
This form of sclerectomy, which aims at decompressing the oncotic choroidal pressure, is an effective treatment for compressive optic neuropathy in the context of nanophthalmos. Could sclerectomy assist in treating other optic neuropathies associated with peripapillary pachychoroid?
小眼球的特征是眼轴长度短、脉络膜厚和巩膜厚。小眼球患者单侧出现有症状的视盘肿胀，在诊断和治疗方面都具有挑战性。
一名59岁健康男性报告称右眼视力在两周内突然下降。右眼的阳性检查结果包括：最佳矫正视力为20/100（+17.25屈光度）、单侧视盘广泛扩大、中心暗点以及轻微的色觉障碍但无传入性瞳孔障碍。神经眼科检查结果为阴性。多次会诊均未为该患者提出任何治疗方案。光学相干断层扫描（OCT）检查显示，视神经乳头小且拥挤，脉络膜弥漫性明显增厚，颞侧视乳头周围区域呈穹顶状且脉络膜扩张。除了从直肌附着处到涡静脉进行圆周方向的前四象限95%深度巩膜切除术外，还对该患者进行了到达视神经鞘的鼻侧后部放射状巩膜切开术。术后2周，患者视力恢复，并持续到6个月的随访期。通过OCT检查，双眼在视盘轮廓和神经纤维层厚度方面相当。
这种旨在减轻脉络膜肿胀压力的巩膜切除术，是治疗小眼球相关压迫性视神经病变的有效方法。巩膜切除术能否有助于治疗其他与视乳头周围厚脉络膜相关的视神经病变？
