Comparing the Results of Vitrectomy and Sclerectomy in a Patient with Nanophthalmic Uveal Effusion Syndrome

Abstract

Nanophthalmic uveal effusion syndrome (UES) is an extremely rare idiopathic disease characterized by a short axial length of the eye, extremely thick sclera and choroid. These structural changes can lead to spontaneous serous detachment of the retina and peripheral choroid. There are many other causes of UES such as trauma, inflammation, cataract surgery, glaucoma, or retinal detachment. UES is classified into three types. All are characterized by a relapsing-remitting clinical course. The loss of visual acuity ranges from mild to very severe, depending on macular involvement. Changes of the retinal pigment epithelium develop secondary after long-standing choroidal effusion and retinal detachment. Subretinal exudates could be seen and mistakenly diagnosed as chorioretinitis. UES can be very difficult to treat. The most commonly used treatment is surgery involving the creation of surgical sclerostomies (scleral window surgery) or partial thickness sclerectomies to support transscleral drainage. In our case, we present a bilateral nanophthalmic UES, which was misdiagnosed as bilateral ocular Vogt−Koyanagi−Harada disease. We documented the course of the disease and the results of the different surgical approaches in both eyes. A pars plana vitrectomy was performed in the right eye and a sclerectomy with sclerostomies in the left eye. In the left eye, even long lasting loss of visual acuity due to a serous retinal detachment was partially reversed.

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.…”

“…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.…”

“…[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.…”

Late Choroidal Neovascular Complications in a Patient Treated for Retinoblastoma. A Case Report

“…V rámci diferenciálnej diagnostiky môžeme zvažovať perzistujúci primárny sklovec (PHPV), morbus Coats, očnú formu toxokarózy, retinopatiu nedonosených [3] alebo iné lézie simulujúce retinoblastóm popri rôznych typoch odlúčenia sietnice [4,5]. Klinicky sa prejavuje v troch rôznych formách a to forma endofytická, kedy rastie z vnútornej jadrovej vrstvy šíri sa priamo do sklovca, ďalej je to forma exofytická, kedy tumor rastie z vonkajšej nukleárnej vrstvy a šíri sa subretinálne a difúzna forma, kedy tumor plošne postihuje celú sietnicu [1].…”

Anterior scleral thickness in patients of central serous chorioretinopathy

“…We excluded controls with refractive error more than three diopters to avoid confounding caused by: scleral thinning in axially elongated eyes, eyes with short axial length and thick sclera, and thinning of anterior sclera with accommodation in myopes. [ 6 7 8 ] Since there is little literature on the measurement of AST,[ 9 10 11 ]we also took the opportunity to assess the agreement of AST measured by anterior segment optical coherence tomography (ASOCT) and ultrasound biomicroscopy (UBM) as well as the relation of AST and CT in patients of CSCR.…”