Bilateral Blebs Secondary to Spontaneous Scleral Perforations

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Purpose:To report an unusual case of bilateral spontaneous scleral perforations.Methods:A 34-year-old woman presented with bilateral conjunctival blebs and decreased vision in both eyes. There was no history of ocular trauma or surgery and no previous ophthalmic or systemic conditions that may have contributed to the scleral perforations.Results:Best-corrected visual acuity was 20/40 in both eyes and intraocular pressures were 6 mm Hg in the right and 5 mm Hg in the left. There was associated bilateral hypotonous maculopathy confirmed with optical coherence tomography. Slit-lamp biomicroscopy revealed bilateral inferonasal conjunctival blebs in otherwise normal anterior segments. Ultrasound biomicroscopy suggested an opening between the anterior chambers and subconjunctival spaces of both eyes. The patient underwent sequential repair of the perforations with sclerocorneal patch grafts. Intraoperatively crescentic perforating scleral clefts were noted in both eyes, with abnormal and friable surrounding tissue. Histopathology revealed degeneration of the sclera with absence of normal lamellar collagenous architecture and structure. At 9 months postoperative for each eye, the best-corrected visual acuity had improved to 20/20 on both eyes and intraocular pressures were 20 mm Hg on the right and 10 mm Hg on the left. Macular anatomy and thickness were restored in both eyes.Conclusions:Spontaneous scleral perforations without prior history of trauma or surgery is extremely rare. The underlying cause in our patient is hypothesized to be a coloboma with spontaneous perforation given its location and histopathology. If symptomatic it can successfully be repaired with a patch graft.

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