STAPHYLOMA (staphyloma; Greek staphyle a bunch + - oma) — protrusion patholologically the changed cornea or a sclera.
Before this term had narrower value — S. was called stretched cataract (see) corneas, the external looking alike soldered to an iris and having a nek-swarm dark grape.
The page of a cornea is formed as a result of the rough destructive changes occurring in the outcome of ulcer keratitis (see) or keratomalacias (see), healing a hem. The last can gradually stretch, be sharoobrazno stuck out, as leads to formation of an ectatic hem, or staphyloma.
Most often it occurs at a perforation of a cornea. At the same time the iris which is carried away by the liquid following from an anterior chamber of an eye or is accustomed to drinking with edges of a perforated opening, or sinks down in it and takes part in formation of a cataract. The anterior chamber of an eye disappears that leads to closing of outflow tracts of intraocular liquid (watery moisture) and development of secondary glaucomas (see). The increased intraocular pressure promotes S.
Razlichayut's education full S. of a cornea with protrusion of all cornea and partial, characterized by protrusion of its limited site. Full S. of a cornea has the conical or hemispherical shape, partial — usually irregular rounded shape. At emergence of a number of additional protrusions of S. of a cornea becomes hilly (lobular S.).
S.'s wall of a cornea is formed by cicatricial connecting fabric. More often it is thinned, sometimes thickened. S.'s surface, as a rule, uneven, is penetrated by neogenic, rather large gyrose vessels. The page of a cornea has grayish-white or dark gray coloring. S.'s cavity represents the expanded anterior chamber of an eye filled with intraocular liquid.
Sometimes S. of a cornea so acts from a palpebral fissure that the smykaniye becomes a century impossible. At long existence of such S. its surface becomes dry, gradually takes a leathery form, quite often ulcerates; its perforation is possible. At the same time intraocular liquid follows from the opened S., her cavity is emptied and it is fallen down. After healing of a perforated opening S.'s cavity is recovered. Sometimes the perforated opening is not closed and formed a resistant fistula. At S.'s ulceration or its fistulas conditions for infection of an eye and development are created entophthalmia (see), the eyeglobe leading to an atrophy. The page of a cornea leads to considerable decrease visual acuities (see). At full S. only photoperception usually remains. At S. complicated by secondary glaucoma without timely operational treatment, as a rule, there comes the total blindness.
The staphyloma of a cornea is observed also at a keratoconus (see. Cornea ), to-rogo is the cornerstone inborn, apparently, the caused underdevelopment and weakness of mesodermal fabric of a cornea is hereditary. At the same time the central part of a cornea under influence even of standard intraocular pressure (see) gradually is stuck out and becomes thinner. The expressed changes of a form of a cornea occur only in the developed stage of a disease, a cut is shown most often at the age of 9 — 20 years and differs in drift. Visual acuity at a keratoconus considerably decreases because of developing of short-sightedness (see) and the wrong astigmatism (see the Astigmatism of an eye), and then due to opacification of top of a keratoconus.
Treatment Page of a cornea operational. The resection S. (staphylotomy) is practically not applied. At full S. corneas make a subtotal through keratoplasty (see the Keratoplasty). When it is impossible to expect a successful outcome of a keratoplasty, make enucleation of an eye (see), and the patient is trained for carrying an eye prosthesis (see. Prosthesis eye ).
At S. of the cornea caused by a keratoconus, the best effect correction by means of contact lenses gives, edges not only improves visual acuity, but also quite often interferes with further protrusion of a cornea. During the progressing of process and opacification of top of a cone make a partial through keratoplasty.
At S. of a cornea the next part of a sclera also is sometimes involved in process that in combination with the increased intraocular pressure can lead scleras to S.'s development. However more often S.'s emergence than a sclera is connected with its inflammation — sclerite (see). In the site of an inflammation on site of the breaking-up fibers of a sclera cicatricial fabric forms, edges under the influence of intraocular pressure can stretch, forming ectasia and S. of a sclera. Depending on localization distinguish the limbalny S. adjacent to a cornea, tsiliarny, or ciliary, S. which is located in the field of a ciliary body and the equatorial S. which is formed in the field of an equator of eyeball. Limbalny S. sometimes arises at far come glaucoma because of thinning of front department of a sclera and high intraocular pressure. Because appears through a vascular path a thin sclera, S. of a sclera has blue or more dark coloring.
The page of back department of a sclera can be observed at short-sightedness of high degree that is caused by the change of structural and biomechanical characteristics of a sclera leading to its gradual stretching.
The village of a sclera usually does not demand treatment. However in extremely exceptional cases of progressing S.'s stretching of a sclera plastic surgeries can be shown on to a sclera (see). To S.'s emergence scleras at high short-sightedness interfere with operation of strengthening of back department of an eye.
Bibliography: The multivolume guide to eye diseases, under the editorship of V. N. Arkhangelsky, t. 2, book 1, page 208, M., 1960; Puchkovskaya N. A. Change of a cornea at the complicated cataracts, Kiev, 1960, bibliogr.; The guide to eye surgery, under the editorship of M. JI. Krasnova, page 101, M., 1976.
E. S. Avetisov.