Senile scleral plaque – Clinical and anterior segment optical coherence tomography correlation

Rama Rajagopal; Maria T Priyanka; Janarthanam J Balaji

doi:10.4103/ijo.IJO_1367_22

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CASE REPORT

Year : 2023 | Volume : 3 | Issue : 1 | Page : 17-18

Senile scleral plaque – Clinical and anterior segment optical coherence tomography correlation

Rama Rajagopal, Maria T Priyanka, Janarthanam J Balaji
Department of Cornea and Refractive Surgery, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India

Date of Submission	04-Jun-2022
Date of Acceptance	09-Sep-2022
Date of Web Publication	20-Jan-2023

Correspondence Address:
Rama Rajagopal
Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai 600 006, Tamil Nadu
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_1367_22

Abstract

Senile scleral plaques are common age-related degenerative changes quite often diagnosed on routine examination. We report a case of an elderly female, incidentally noted to have clinical findings suggestive of a senile scleral plaque. Anterior segment optical coherence tomography (AS-OCT) concurred with clinical findings. They are in general non-progressive or slowly progressive. Although the risk of progression is rare, considering the rare possibility of perforation, we recommend periodic review both clinically and with AS-OCT. Imaging may also be valuable in patients with senile scleral plaques undergoing scleral procedures and repeated intravitreal injections to understand the possible risks of perforation.

Keywords: Anterior segment OCT, hyaline degeneration, scleral thinning, senile scleral plaque

How to cite this article:
Rajagopal R, Priyanka MT, Balaji JJ. Senile scleral plaque – Clinical and anterior segment optical coherence tomography correlation. Indian J Ophthalmol Case Rep 2023;3:17-8

How to cite this URL:
Rajagopal R, Priyanka MT, Balaji JJ. Senile scleral plaque – Clinical and anterior segment optical coherence tomography correlation. Indian J Ophthalmol Case Rep [serial online] 2023 [cited 2023 Feb 1];3:17-8. Available from: https://www.ijoreports.in/text.asp?2023/3/1/17/368136

Scleral scleral plaques (SSPs) are commonly seen in the elderly^[1] with a prevalence of 8.2%.^[2] They are symmetric, sharply demarcated slate gray vertical elliptical areas, measuring around 2 (width) ×5–6 (length) mm, have variable depths, are located 3 mm from limbus, and are anterior and parallel to the line of muscle insertion.^[3] The overlying episcleral and conjunctival vessels show tortuosity, consistent with the age-related atherosclerotic status of the patient.^[4]

SSPs are translucent because of age-related hyaline degeneration of the scleral fibers but slate gray as underlying uvea is seen through.^[3] Rarely, progressive degeneration and thinning can lead to perforation.^[3] Here, we report the clinical correlation of SSP with anterior segment optical coherence tomography (AS-OCT) and its role in patients with SSP requiring vitreoretinal intervention.

Case Report

A 62-year-old female presented with asymptomatic non-progressive bilateral slate gray vertical elliptical areas on the temporal bulbar conjunctiva (4 × 1.5 mm, 5.5 × 2 mm in the right and left eye, respectively) [Figure 1]a and [Figure 1]b, located anterior to the insertion of lateral rectus muscle suggestive of SSP. She had no connective tissue disorders.

Figure 1: (a and b): Clinical photograph of a senile scleral plaque (black arrow representing lateral rectus muscle insertion). (c and d): Representative AS-OCT image of the senile scleral plaque of the right and left eye, respectively. Horizontal section showing the distance of the anterior border of SSP from limbus in the right eye (3.7 mm) and left eye (3.1 mm), respectively, and in relation to lateral rectus muscle insertion. Vertical section showing blood vessels represented by red arrows

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The AS-OCT image was obtained from ZEISS CIRRUS 5000 HD AS-OCT [Figure 1]c and [Figure 1]d. SSP appears hypo-reflective because of the hyalinized translucent scleral fibers, and the dilated, tortuous conjunctival vessels appear as hypo-reflective circular areas (red arrows). The distance of the SSP from the limbus in relation to the lateral rectus muscle and overlying vessels noted clinically corroborated with the AS-OCT image.

Discussion

Senile sclera plaques are found to be in relation to the muscle insertions because of stress and strain on the sclera by the action of muscles. It occurs in senile subjects because of dehydration and scleral ischemia following age-related atherosclerosis. They remain stable or calcified or progressively thin, leading to scleromalacia and perforation.^[3] AS-OCT helps to confirm and objectively quantify the extent of thinning. Serial AS-OCT can identify progressive thinning before it is clinically evident. In patients undergoing intravitreal injections or scleral procedures, along with a routine scleral examination for areas of thinning, AS-OCT is recommended to understand risks of perforation.^[2] Besides, it can also help in differentiating it from mimicking lesions, namely, necrotizing scleritis, scleromalacia perforans, conjunctival malignant melanoma, and choroidal melanoma^[5] when in doubt.

Conclusion

SSPs are managed conservatively with periodic review, and AS-OCT helps to objectively complement the clinical diagnosis, monitor progressive scleral thinning, and aid in surgical planning.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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