Extensive circumferential partial-thickness sclerectomy in eyes with extreme nanophthalmos and spontaneous uveal effusion

Abstract

AimTo describe an extensive scleral excision technique to treat uveal effusion in nanophthalmic eyes.MethodsThis prospective, interventional series of eight eyes of five consecutive patients with nanophthalmos underwent scleral window surgeries. Ninety per cent of the scleral thickness, extending from immediately behind the extraocular muscle insertions to the vortex veins for 3 and 1/4 quadrants, was removed. The main outcome measure was resolution of the uveal effusions.ResultsEight eyes of five patients (one female and four male) with a mean age of 46 years were studied. The mean (range) axial length was 16.1 mm (14.6–17.6 mm), and the mean refractive error was +13.6 dioptres (+10.75 to +16.00 dioptres). Following scleral excision surgery, all uveal effusions resolved within an average (±SD) of 13.9 (±8.7) days. The uveal effusion recurred in only one eye that had a vasoproliferative retinal tumour. The mean best corrected visual acuity improved from 0.69 logarithm of the minimum angle of resolution (logMAR) (Snellen equivalent: 20/97) at baseline to 0.51 logMAR (Snellen equivalent: 20/64; Wilcoxon paired t-test: p=0.016) after a mean follow-up of 35.6 months.ConclusionThe circumferential scleral window technique produces rapid resolution of uveal effusion in nanophthalmic eyes. No adverse effects were noted after surgery and the clinical effect was durable through 1 year.Trial registration numberNCT03748732.

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

“…Many of their cases were firstly misdiagnosed as choroidal melanoma (47%), choroidal metastasis (3%), choroidal tumor nonspecified (34%) and only 16% was diagnosed correctly as UES [10]. In type 1 UES, 65% of the cases eventually become bilateral, which is the case with our patient [11].…”

“…The most commonly used treatment is surgery involving the creation of surgical sclerostomies (scleral window surgery) or partial thickness sclerectomies to support transscleral drainage [1,8,9]. In some cases, steroids or NSAID may be effective [10,11].…”

The Pathogenesis and Treatment of Complications in Nanophthalmos

“…The resistance of the transscleral sclera to protein movement decreases after sclerectomy, although this may be affected by the amount of sclera excised and postoperative fibrous scarring [ 63 ]. A prospective study showed that partial quadrant PTS (90% of the scleral thickness) in nanophthalmic eyes with UES had a significant effect [ 64 ], and PTS produced better results in the four quadrants [ 65 ]. The authors of the study considered that the PTS performed in the four quadrants could reduce the overall resistance to subchoroidal fluid outflow, thereby promoting the outflow of fluids in the suprachoroidal and subretinal spaces [ 64 , 65 ].…”

“…A prospective study showed that partial quadrant PTS (90% of the scleral thickness) in nanophthalmic eyes with UES had a significant effect [ 64 ], and PTS produced better results in the four quadrants [ 65 ]. The authors of the study considered that the PTS performed in the four quadrants could reduce the overall resistance to subchoroidal fluid outflow, thereby promoting the outflow of fluids in the suprachoroidal and subretinal spaces [ 64 , 65 ]. However, due to the large area of sclera removed, current technology may cause dilation of the sclera [ 64 ].…”

“…The authors of the study considered that the PTS performed in the four quadrants could reduce the overall resistance to subchoroidal fluid outflow, thereby promoting the outflow of fluids in the suprachoroidal and subretinal spaces [ 64 , 65 ]. However, due to the large area of sclera removed, current technology may cause dilation of the sclera [ 64 ]. PTS combined with mitomycin C (MMC): episcleral scarring can lead to closure of scleral windows [ 63 ].…”