Quadrantic vortex vein decompression with subretinal fluid drainage for manangement of Nanophthalmic choroidal effusions— a review of literature and case series

Khatri, Anadi; Singh, Sweta; Joshi, Kriti; Kharel, Muna

doi:10.1186/s12886-019-1213-z

Cited by 6 publications

(7 citation statements)

References 14 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Mansour,

López-Guajardo,

Özdek

et al. 2023

Journal of VitreoRetinal Diseases

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Purpose:To describe the visual outcomes and problems that resulted from surgical treatment of nanophthalmic complete retinal detachment (RD) with retina–lens contact. Methods: A multicenter retrospective case series with deep sclerectomy as a treatment was performed. Results: Five cases had extensive deep sclerectomies, 3 with intended drainage of subretinal fluid (SRF). The RD resolved 1 week postoperatively in 4 cases and within 1 month in 1 case. The visual acuity improved from light perception to a median of 20/100. Three cases had longstanding lens touch beyond 1 year and improved VA to 20/100, 20/150, and hand motions, respectively. Complications included focal lens dialysis in 2 cases (passive drainage of SRF) and lens or intraocular lens dislocation in 1 case each (active drainage of SRF). Ultrasound biomicroscopy and anterior optical coherence tomography showed a very narrow angle and short zonules. Conclusions: Deep sclerectomy results in good anatomic and functional improvements in advanced cases of nanophthalmos exudative detachment, which is often considered to be incurable.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Mansour,

López-Guajardo,

Özdek

et al. 2023

Journal of VitreoRetinal Diseases

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“…This approach was recently described in two other cases in the literature, with similar results and no complications. 26 Therefore, external drainage of subretinal fluid can be performed in addition to sclerectomies for very advanced, highly bullous UE and might lead to a quicker and better response.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Nanophthalmos-Related Uveal Effusion with Two- vs. Four-Quadrant Partial-Thickness Sclerectomy and Sclerotomy Surgery

Özdek¹,

Yalınbaş²,

Özmen³

et al. 2022

tjo

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Objectives: To report visual and anatomical outcomes following two- or four-quadrant partial-thickness sclerectomy and sclerotomy surgery to treat nanophthalmos (NO)-related uveal effusion (UE). Materials and Methods: Consecutive patients with NO-related UE were treated with four-quadrant or two-quadrant (for those with associated glaucoma) partial-thickness sclerectomy and sclerotomy surgery. Axial length, extent of UE, preoperative, postoperative, and final best corrected visual acuity (BCVA), time to retinal reattachment, and rates of retinal reattachment and recurrence were noted. Results: Fourteen eyes of 10 patients with NO-related UE were operated. Retinal detachment (RD) involved mainly the peripheral retina in 7 (50%) eyes, macula in 2 eyes (14.2%), both macula and peripheral retina in 4 eyes (28.6%), and the whole retina in 1 eye. Eleven eyes had four-quadrant surgery, and 3 eyes with associated glaucoma had two-quadrant surgery. External subretinal drainage was performed in one patient who had total RD. The mean preoperative logMAR BCVA of 1.50±0.53 increased significantly to 0.92±0.49 after surgery (p=0.002). Resolution of RD could be achieved with two-quadrant surgery in only 1 of 3 eyes. In the other 2 eyes, retinal reattachment was achieved after a secondary surgery for the remaining two quadrants to complete four-quadrant sclerectomy. Final outcome was total reattachment of the retina in 11 eyes (78.6%), partial reattachment in 1 eye (7.1%), and recurrence of macular detachment in 2 (14.3%) eyes. Conclusion: Quadrantic partial-thickness sclerectomy and sclerotomy surgery seems effective for treating UE in eyes with NO. Twoquadrant surgery may be tried for mild UE associated with glaucoma to preserve the superior quadrants for future possible glaucoma surgeries, but secondary surgery for the superior quadrants may be needed. External drainage of subretinal fluid may be an option in severe cases to achieve quicker resolution.

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“…Similarly two quadrantic vein decompression with subretinal fluid drainage at the same setting also revealed promising result but the cases have short follow up period. 16 This condition can be overlooked easily and attempted to be managed with laser peripheral iridotomy for high IOP and shallow anterior chamber. 17 Nonetheless, the sudden drop in IOP after a peripheral iridotomy, results in a relative increase in the choroidal venous pressure and an aggravation of the uveal effusion.…”

Section: Discussionmentioning

confidence: 99%

Partial Thickness Sclerectomy for Uveal Effusion Syndrome in nanophthalmic eyes

et al. 2021

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Introduction: Nanophthalmos characterized by short axial length, high lens-to-eye ratio and thick sclera, is more prone to develop uveal effusion syndrome (UES). This rare entity can result in idiopathic exudative detachment of the choroid, ciliary body and retina. Abnormality in the scleral thickness with resultant obstruction of the vortex veins and reduced trans-scleral drainage of fluid is responsible for exudative retinal detachment (ERD). Methods: A retrospective study of UES in nanophthalmic patients treated with partial thickness sclerectomy in tertiary eye care centre from January 2015 to June 2019. Five eyes of five patients (four males and one female) with a diagnosis of nanophthalmos suffered from angle closure glaucoma associated with ERD. Raised intra-ocular pressure (IOP) not amenable to conservative medical management were subjected to surgery. Lamellar sclerectomy was performed in two or more quadrants without drainage which was judged on the basis of maximum amount of exudative fluid present in the subsequent quadrants. Results: The average age at surgery was 39.2 years and the mean follow-up duration was 9.2 months (6 to 18 months). Revision sclerectomy was required in 2/5 (60%) eyes. The serous fluid gradually resolved and retina remained reattached at the end of final follow up. The useful vision was preserved and IOP was normalized. Conclusion: Nanophthalmic UES remains a challenging clinical entity. Partial thickness sclerectomy may be an effective option in the treatment of nanophthalmic UES, not amenable to the conventional medical management in a low resource setup.

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Quadrantic vortex vein decompression with subretinal fluid drainage for manangement of Nanophthalmic choroidal effusions— a review of literature and case series

Cited by 6 publications

References 14 publications

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

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

Treatment of Nanophthalmos-Related Uveal Effusion with Two- vs. Four-Quadrant Partial-Thickness Sclerectomy and Sclerotomy Surgery

Partial Thickness Sclerectomy for Uveal Effusion Syndrome in nanophthalmic eyes

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