Exudative retinal detachment and posterior scleritis associated with massive scleral thickening and calcification treated by scleral decompression.

Abstract

A 66-year-old man presented with massive bilateral scieral thickening and calcification associated with a unilateral exudative retinal detachment which did not respond to systemic anti-inflammatory agents including steroids and cyclophosphamide but improved with scleral resection. This patient shows the features of both posterior scleritis and the uveal effusion syndrome, providing further evidence for the role of a thickened sclera and interference with the trans-scleral flow of fluid in the formation of such an exudative retinal detachment.

Síndrome de efusión uveal secundario a cirugía de estrabismo

“…La diferencia clínica fundamental entre la efusión uveal primaria o idiopática y la secundaria a una escleritis posterior es la ausencia de dolor en el primer caso, mientras que la pérdida de visión se produce gravemente en ambas debido al DR exudativo que afecta a la mácula (3,4).…”

The role of Scheimpflug imaging in the management of posterior scleritis

“…4 Posterior scleritis can be asymptomatic, but symptoms can include pain (especially on eye movement) photophobia, and blurred vision. Signs can include associated anterior scleritis, exudative retinal detachment, 5 optic disc swelling, subretinal granulomata formation, elevated IOP, choroidal effusion, 6 uveitis, and retinal vasculitis. In a large retrospective study, no abnormalities were present in 17% of those who had a final diagnosis of posterior scleritis, and visual loss can occur in up to 30% of patients.…”

Bilateral Uveal Effusion Associated With Scleral Thickening Due to Amyloidosis

“…Medical treatment and conventional vitreoretinal surgery are ineffective in treating the uveal effu-sion seen in idiopathic uveal effusion syndrome and nanophthalmos. [4][5][6] Partial-thickness sclerectomy and vortex vein decompression is a welldocumented procedure for uveal effusion associated with abnormally thickened sclera. 6 The presence of uveal effusion in this patient with ocular amyloidosis and the success of scleral surgery in relieving the effusions supports the theory that an abnormally thickened sclera interferes with the normal transcleral flow of fluid.…”

“…[4][5][6] Partial-thickness sclerectomy and vortex vein decompression is a welldocumented procedure for uveal effusion associated with abnormally thickened sclera. 6 The presence of uveal effusion in this patient with ocular amyloidosis and the success of scleral surgery in relieving the effusions supports the theory that an abnormally thickened sclera interferes with the normal transcleral flow of fluid. 4 This disturbance of bulk fluid flow across the choroid and sclera leads to accumulation of proteinaceous fluid in the choroid and subretinal space and the clinical appearance of shifting subretinal fluid characteristic of nonrhegmatogenous retinal detachment.…”