Medical therapy for uveal effusion syndrome

Abstract

Purpose To report a case series of three patients with bilateral uveal effusion syndrome (UES), treated conservatively with oral carbonic anhydrase inhibitors and topical prostaglandin analogues (PAs). Methods Three patients with bilateral UES were treated with the same initial therapy. Topical PA latanoprost 0.005% and acetazolamide 250 mg were administered in order to reduce intraocular pressure, improve uveoscleral outflow, and facilitate resolution of uveal effusion. Results The chorioretinal detachment resolved within 3 months in two reported patients while the third one underwent surgery on his left eye. After clinical improvement, further oral therapy with acetazolamide was stopped, while topical prostaglandins were continued for at least the next 3 months. All patients were free from recurrence during the follow-up period. Conclusion Although the usually recommended UES therapy is partial or full-thickness sclerectomy, our case series showed apparent resolution of chorioretinal detachment in two patients on medical therapy alone. Conservative therapy may be the first step before the standard recommended surgical approach, but further studies are needed to verify the effectiveness of reported therapy.

Unusual rapid resolution of postsclerectomy exudative retinal detachment with topical NSAIDs therapy in a case of nanophthalmos

“…11 Furthermore, prostaglandin administration could reduce scleral collagen levels by increasing scleral metalloproteinase levels, thus stimulating the pump mechanism of the retinal pigment epithelium and facilitating reabsorption of the fluid. 11 , 14 Psychological factors might also have contributed to recovery because, during treatment for the second instance of ERD, the patient was calmer and more relaxed than during treatment for the first instance of ERD. It has been shown that long-term anxiety can cause imbalances in certain chemicals, such as 5-hydroxytryptamine, norepinephrine, and dopamine, leading to disturbances in body functions, such as local edema and stress-induced inflammatory exudation.…”

Medical Therapy and Scleral Windows for Uveal Effusion Syndrome: A Case Series and Literature Review

“…Table 6 presents outcomes of various medical therapies to treat UES in recent reports. This includes steroids, topical NSAIDs, prostaglandin analogues, carbonic anhydrase inhibitors, anti-VEGF, or a combination of medical therapies [55][56][57][58].…”

“…This includes steroids, topical NSAIDs, prostaglandin analogues, carbonic anhydrase inhibitors, anti-VEGF, or a combination of medical therapies [ 55 – 58 ].…”

“…In UES, Derk et al successfully treated three eyes with bilateral UES with a combination of topical latanoprost and orally administered acetazolamide. Similarly, Park et al treated one case with the same regimen [ 58 ].…”

The Pathogenesis and Treatment of Complications in Nanophthalmos

“…The mechanism behind this may be that VEGF can reduce the activation of macrophages and further regulate the expression of IL-6 and IL-8 [ 71 , 72 ]. The reports of Park and Andrijevic Dert et al [ 73 , 74 ] show that oral carbonic anhydrase inhibitors and local prostaglandin analogues can help the absorption of subretinal fluid and improve the detached choroid and retina in nanophthalmic eyes with UES. There may be two possible mechanisms for this: on one hand, the prostaglandin analogues decrease the level of scleral collagens by increasing the level of scleral metalloproteinase, thus regulating the flow of fluids through the sclera and increasing the permeability of scleral macromolecules [ 75 ].…”