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

Abstract

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.

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.…”

Cataract surgery in adult eyes with short axial length

“…The study included eight nanophthalmic eyes with uveal effusion and reported resolution of the effusion in all eyes with an average of 13.9 days, however, the effusion recurred in one eye with a retinal vasoproliferative tumor [56]. In a recent study, Ozdek and colleagues found that in nanophtahlmic-related effusion, performing four-quadrants sclerectectomies was more effective than two-quadrants sclerectomies [57]. While the majority of the literature is focused on partial thickness sclerectomy, full thickness scleral cuts have also been performed [58].…”