Paper 102 Disc

Veterinary Ophthalmology (2000) 3, 27±29

Congenital scleral staphyloma in a dog repaired with preserved

homologous peritoneum
Paulo S. M. Barros and Angelica M. V. Safatle
Ophthalmology Section, Department of Surgery, School of Veterinary Medicine, University of SaÄo Paulo, SaÄo Paulo, Brazil

Address communications to: Abstract

Dr Barros A case of congenital scleral staphyloma was treated with a preserved homologous
Rua Caiowaa peritoneum graft. A 2-year-old female poodle with a blue-gray mass in a dorsal and
1236 ap. 204 temporal position of the sclera of the left eye was evaluated. The repair of the scleral defect
05018±001 with a graft of preserved homologous peritoneum reduced the strabismus and the size of
SaÄo Paulo Ahed
the staphyloma, and improved the cosmetic appearance of the eye.
Brazil Bhed
Fax: + 55 11 2632851 Key Words: dog, peritoneum, sclera, scleral graft, staphyloma Ched
e-mail: pauloeye@usp.br Dhed
Ref mar-
ker
INTRODUCTION tion revealed a ventral and medial deviation of the left globe Fig mar-
and the presence of a blue-gray soft mass with diameter of 10 ker
The sclera is composed of irregularly arranged collagen and mm in a dorsal and temporal position of the sclera (Fig. 1). T a b l e
elastic fibers. When this arrangement is not properly The dog seemed to be visual, and according to the owner the marker
formed, a thin sclera may result as the intraocular pressure mass had been slowly enlarging since the animal was very Ref end
(IOP) can cause protrusion of uveal tissues into the young. No other signs associated with inflammation or pain Ref start
weakened sclera. Inflammatory diseases associated with the were observed. The anterior segment of the eye was normal
connective tissue, such as rheumatoid arthritis in human and fundus examination showed no abnormalities. Ultra-
beings, can cause thinning of the sclera and protusion of the sound examination was not available. The initial diagnosis
1±3
underlying uveal tissue. Although rheumatoid arthritis was uveal melanoma compromising scleral tissue, and
4
occurs in dogs, necrotizing scleritis with destruction of surgical removal of the neoplasia was proposed.
fibers of the collagen of the sclera has not been described in the
5
literature. Acquired lesions from trauma, surgery, tumors and Surgical procedure
chronic glaucoma can cause structural alteration of the sclera After standard preoperative procedures and under general
and limbus, resulting in bulging of the uveal tissues. anesthesia, a limbal-based conjunctival flap was prepared. As
Congenital eye defects, such as scleral colobomas, have the sclera was very thin the uveal tissue could be directly
been reported in dogs, although congenital diseases of the observed (Fig. 2). The exposed black mass was smooth,
sclera are not frequently referred to in the veterinary reducible and filled by fluid, although when punctured using
literature. Collie eye anomaly,6 ocular dysgenesis in a 22-g hypodermic needle, no material was collected. A
Australian Shepherd dogs,7 and Ehlers±Danlos syndrome8 diagnosis of staphyloma was then made.
are among the diseases that can cause scleral colobomas. To reinforce the thin sclera, a piece of homologous
Congenital scleral staphyloma may be presented as a dark peritoneum preserved in glycerol was sutured over the bulging
mass beneath the conjunctiva due to a bulging of the uveal tissue using 9±0 prolene interrupted sutures (Fig. 3) which was
tissue, and is usually associated with multiple anomalies.9 then covered with a conjunctival flap (7±0 Vicryl continuous
This condition was observed by Mitterer et al.10 in a 3.5- sutures). An antibiotic-corticosteroid (gentamicin±dexametha-
month-old German Shepherd that presented a blue-gray sone) ointment was prescribed four times daily for 10 days.
mass at the temporal position beneath the conjunctiva. This Examination of the left eye 3 months after surgery revealed
report describes a case of congenital scleral staphyloma in a a comfortable eye and the graft was well integrated. The
Miniature Poodle that was successfully repaired surgically overall size of the staphyloma and the degree of the strabismus
using a graft of peritoneum preserved in glycerol. were reduced (Fig. 4). There was no evidence of other
alterations of the anterior or posterior segments of the eye.
CASE REPORT
DISCUSSION
A 2-year-old female Miniature Poodle was referred for
examination at the Ophthalmic Section, School of Veter- Congenital staphyloma or a bulging of weakened sclera lined
inary Medicine, University of SaÄo Paulo. Physical examina- by uveal tissues is a rare condition in the dog, with only a few

# 2000 American College of Veterinary Ophthalmologists


28 BARROS AND SAFATLE
Figure 1. Black mass underneath the thin sclera and conjunctiva at the
presentation.
Figure 2. Appearance of the uveal tissue after dissection of the
conjunctiva and the thin sclera.
cases being reported in the veterinary literature. Our case is
very similar to that documented by Mitterer et al..10 In both
cases the aspect and position of the blue-gray mass were the
same, and a strabismus with great eye deviation was present.
As the dog had not shown any other local or systemic
alteration, we can believe that a congenital malformation of
the scleral tissue was the cause of the thinning of this structure.
A differential diagnosis from uveal melanoma compromis-
ing the sclera must be considered. The softness of the mass
could be the most useful sign to differentiate from a hard
tumor mass as well as an ultrasound examination.
To relieve the signs, reinforcement of the sclera is
imperative. A variety of grafts have been used with different
results to repair the scleral defects in human beings with
scleromalacia perforans.3±16 As the biological membranes
have been shown to be of usefulness in the repair of several
tissues and structures,17±21 use of the peritoneum as a patch
to strengthen the scleral defect was selected. Due to the
thinness of the sclera, histopathology was not performed as
tissue excision could rupture the sclera with the extrusion of
the uveal tissue. With this procedure, good results were
obtained with increase in the thickness of the sclera and
reduction of the strabismus.
# 2000 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 3, 27±29
Paper 102 Disc
Figure 3. Attachment of the peritoneum patch over the scleral
staphyloma.
Figure 4. Appearance of the left eye 3 months after surgery.
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# 2000 American College of Veterinary Ophthalmologists, Veterinary Ophthalmology, 3, 27±29
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CONGENITAL SCLERAL STAPHYLOMA IN A DOG 29
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