Clinical presentation and treatment outcomes of an algorithmic approach to uveal effusion syndrome

Abstract

Purpose: To describe the clinical features and treatment outcomes in spontaneous uveal effusion syndrome (UES). Methods: A 10-year retrospective chart review of UES patients from a tertiary eye center was carried out. Optical coherence tomography (OCT), fundus fluorescein angiography, and ultrasound biomicroscopy (UBM) scans were performed. UES was managed based on presenting best-corrected visual acuity (BCVA), symptoms, and fundus findings. Patients with secondary causes of uveal effusion were excluded. Results: Twenty-five eyes of 16 patients were included. Of the 16 patients, 14 (88%) were male and 9 (56%) had bilateral disease. Fifteen of 25 affected eyes had nanophthalmos (axial length (AL) <20.5 mm) and 6 had hyperopia with AL >20.5 mm. The presenting mean distance BCVA was 0.74 ± 0.64 logMAR (mean Snellen: 20/100). Eleven eyes had exudative retinal detachment, and 4 also had exudative choroidal detachment (CD). Choroidal thickness (CT) was increased in 11 eyes on B-scan ultrasonography, and the mean CT was 1.74 ± 0.38 mm. Sub-retinal fluid (SRF) and retinal folds were the most common OCT findings. UBM findings included shallow angles, peripheral CD, and supra-ciliary effusion. A combination of local and systemic corticosteroids was used to successfully treat 12 eyes, 6 needed surgery, and 7 were observed. Partial sclerectomy with anterior chamber maintainer-assisted SRF drainage was the favored surgery. The median period of follow-up was 6.5 months (0.1–76 months), and the mean distance BCVA at the last follow-up was 0.58 ± 0.42 logMAR (mean Snellen: 20/80). Conclusion: UES can be suitably managed both medically and surgically based on clinical presentation.

Surgical Approaches to Serous Retinal Detachment With Retina–Lens Touch in Eyes With Nanophthalmos

“…Special anatomic features of nanophthalmos. [5][6][7][8][9][10][11][12][13][14][15][16][17][18] zonular dialysis occurred after a cotton applicator was applied to the injection site in an effort to control the reflux of hyaluronic acid or air. The lens dislocated into the vitreous cavity in Cases 4 and 5 after the eye was reinflated with a balanced salt solution injected through a limbal incision.…”

“…31 Medical therapy with oral corticosteroids in uveal effusion syndrome is well established but was deemed ineffective in nanophthalmos. 10,11 Elgin et al 9 described a patient with nanophthalmos and mild exudative RD that resolved rapidly after administration of the topical corticosteroid alone. The authors suggested that the corticosteroid reduced inflammation and stabilized the blood-ocular barrier, thereby improving regression.…”

“…These eyes have very anterior insertion of the retina, a large lens, short zonules, a shallow anterior chamber (AC) (with a propensity for angle closure), and a noticeably thickened sclera and choroid (Figure 1). [5][6][7][8][9][10][11][12][13][14][15][16][17][18] Vitrectomy is dangerous because it can result in peripheral holes (anterior retinal insertion), 12 which can cause an exudative RD to become more complex and require silicone oil tamponade or multiple surgical procedures. 12,13 In this case series, we describe the anatomic and visual results of surgical procedures for serous RD with retina-lens touch in eyes with nanophthalmos.…”