Successful Closure of Spontaneous Scleral Fistula in Retinochoroidal Coloboma

A clinical and optical coherence tomography study of choroidal colobomas

“…Gupta et al [39] described a similar case of spontaneous fistula in the area of coloboma that was successfully managed with use of cyanoacrylate glue and scleral patch grafting. Both cases maintained attached retina status on follow-up.…”

Structural organization of choroidal colobomas of young and adult patients and mechanism of retinal detachment

“…Two more recent reports have described spontaneous ruptures of the thin sclera forming the floor of chorioretinal colobomas. 40,41 In both of the cases reported, a leaking fistula was complicated by hypotony and had to be repaired surgically. Even though these defects involved the sclera and intercalary membrane, there was no associated retinal detachment, a finding that is consistent with the suggestion that there is an intact barrier at the margin of colobomas.…”

“…Yet these early descriptions were forgotten long before scleral buckling (in the1960s) and vitreoretinal techniques (in the 1980s) provided some measure of therapeutic success. 2,3,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] Clinically, however, surgeons specializing in retinal detachments were likely to see only colobomas of medium severity. Severity and age at onset are related in that severe colobomas are part of multiple malformations 45,46 and were, therefore, more likely to be the subject of ophthalmic pathological study.…”

Surgical Management of Scleral Defects

“…Scleromalacia perforans associated with rheumatoid arthritis, spontaneous perforation of retinochoroidal coloboma, and underlying connective tissue disorders such as Marfan syndrome are other rare etiologic or predisposing factors for scleral defects. 1,3,[5][6][7] Scleral defects with or without bleb leak can be treated by several methods. These include conservative procedures such as bandage contact lens or symblepharon ring application 3,4 ; simple interventions such as the application of cyanoacrylate adhesive 5,8 or fibrin glue, 6,9 electrical or chemical cauterization with trichloroacetic acid, 10,11 cryotherapy, 12 laser, 2,13 direct suturing, 4,14 intrableb autologous blood injection, 2,15 and more complicated operations such as patching with conjunctiva, 3,16 cartilage, 3 fascia lata, 1,3 periosteum, mucous membrane and dermal graft, 1,3 dura mater, 1,6 amniotic membrane, 7,17 or scleral 7,18,19 or corneal graft.…”