👁️SCLEROMALACIA PERFORANS 👁️

Scleromalacia perforans is a rare, bilateral condition, occurring predominantly among elderly females with a history of severe, progressive, long-standing rheumatoid arthritis with extra-articular manifestations. In fact, rheumatoid arthritis was the only associated systemic disease found in 46% and 67% of patients with scleromalacia perforans studied by Watson & Hazleman and Sainz de la Maza et al. respectively. Ocular complications, including keratitis, uveitis, glaucoma, cataract, and macular edema, are not infrequent, resulting in visual loss in about a third of patients. In contrast to necrotizing scleritis with inflammation, the eye is not painful. The condition is characterized by the appearance of yellow to grayish patches on the sclera that gradually develop a necrotic slough or sequestrum which eventually separates from the underlying sclera, leaving bare choroid, covered by a thin layer of fibrous tissue or conjunctiva. Progression can be prevented if treatment is instituted early. An initial characteristic finding on slit-lamp examination is a reduction in the number and size of vessels in the episclera surrounding the sequestrum, giving porcelain-like appearance. These vessels anastomose with each other and sometimes cross the abnormal area to join with perilimbal vessels. The necrotic process in scleromalacia perforans appears to be caused by arteriolar obliteration as evidenced by FA, as opposed to venular nonperfusion, which is more prominent in necrotizing scleritis.The initial color changes in sclera from porcelain white to yellow are often noted by the patient while looking in the mirror, by the patient's family, rheumatologist, or on routine ocular exam. The areas of exposed choroid are conspicuous, appearing blue-black in color. Staphyloma do not develop unless the intraocular pressure is persistently elevated. While spontaneous perforation is rare, these eyes are quite susceptible to traumatic rupture.

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Yes it is very important useful and God bless you Doctor

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Very informative post

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Informative post

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