title: Amniotic bands as a cause of congenital anterior staphyloma.
abstract: BACKGROUND
  Congenital anterior staphyloma is a rare, complex malformation syndrome of the anterior segment. Only a few reports on associated systemic malformations have been published. We herein present a rare manifestation of congenital anterior staphyloma (CAS) combined with amniotic band disruption syndrome (ABS).
  
  
  METHODS
  Shortly after birth, a massive enlargement of the left eye was observed in a female child. Furthermore, an extensive bilateral congenital cleft lip and cleft alveolar ridge with oblique facial cleft extending into the left medial canthal region, coloboma(s) of the left eyelids, extensive adhesions between lids and eye bulb, as well as circumferential grooves, clubfeet, and terminal transverse defects in both hands and feet were present. Due to severe progression of eye bulb protrusion with thinning of the sclera, enucleation of the left eye was performed at the age of 3 years in order to prevent complications including perforation of the globe and with the aim of improving cosmetic aspects.
  
  
  RESULTS
  Histopathological examination of the enucleated eye disclosed findings typical of congenital anterior staphyloma, including massive corneal staphylomatic deformation with superficial vascularization and elapsed corneoscleral margin, destruction of Bowman's layer, absence of Descemet's layer, corneal endothelium, and angle structures. The lens was only partially formed, and had mainly dissolved. The neural retina appeared normal. The optic nerve disc revealed a pronounced excavation. Facial clefts, lid colobomas, congenital constriction bands, and amputation of distal limbs match ABS. This malformation complex develops in early pregnancy, probably prior to 35 days post conception.
  
  
  CONCLUSIONS
  This is the first report on an association of these two rare complex congenital malformations, congenital anterior staphyloma and amniotic band syndrome. The anterior staphyloma was unilateral, and related to facial clefts and lid coloboma in the area adjacent to the anterior staphyloma. Furthermore, the systemic deformities are clearly due to the amniotic bands, and the timing of the development of both complex malformations seems to be similar. All findings suggest that the presence of amniotic bands is a causative factor for all observed abnormalities including anterior staphyloma.
authors.affiliation: Department of Ophthalmology, University Hospital Tübingen, Schleichstr 12-16, 72076 Tübingen, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Schramm
authors.forename: Jens M
authors.initials: JM
authors.lastname: Rohrbach
authors.forename: Siegmar
authors.initials: S
authors.lastname: Reinert
authors.forename: Ulrike A
authors.initials: UA
authors.lastname: Mau-Holzmann
authors.forename: Sabine
authors.initials: S
authors.lastname: Aisenbrey
authors.forename: Karl-Ulrich
authors.initials: KU
authors.lastname: Bartz-Schmidt
authors.forename: Dorothea
authors.initials: D
authors.lastname: Besch
mesh_terms: D000015:Abnormalities, Multiple; D000652:Amniotic Band Syndrome / Q000150:complications* / Q000175:diagnosis; D000867:Anterior Chamber / Q000002:abnormalities*; D001035:Aphakia / Q000151:congenital* / Q000601:surgery; D002972:Cleft Palate / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D003103:Coloboma / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D003315:Cornea / Q000002:abnormalities*; D003316:Corneal Diseases / Q000151:congenital* / Q000601:surgery; D003394:Craniofacial Dysostosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005124:Eye Abnormalities / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D015353:Eye Enucleation; D005143:Eyelids / Q000002:abnormalities; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019767:Maxillofacial Abnormalities / Q000175:diagnosis / Q000209:etiology / Q000601:surgery