UBM-guided scleral buckling for Schwartz-Matsuo syndrome with tear of nonpigmented epithelium of the ciliary body: a case report

Abstract

Background Tears in Schwartz-Matsuo syndrome are generally confirmed by preoperative ophthalmoscopic examination. A case of Schwartz-Matsuo syndrome with a tear detected by ultrasound biomicroscopy (UBM) and treated by UBM-guided scleral buckling was reported, and its mechanism was analysed. Case presentation A 40-year-old Chinese man presented with blurry vision and intermittent eye pain in his left eye for three days. The visual acuity of the left eye decreased from 20/20 to 20/40, and the intraocular pressure (IOP) fluctuated dramatically from 24.0 mmHg to 56.7 mmHg at the first visit. Gonioscopy revealed that the chamber angle remained open. A macula-involving inferior retinal detachment extending from 4:30 to 9:30 with no obvious causative break was observed through ophthalmoscopic examination. However, a single small tear was detected at the nonpigmented epithelium of pars plana of the ciliary body at approximately 7–8 o’clock by UBM. The loss of photoreceptor outer segments and ellipsoid zone and the existence of macular microcysts in the inner and outer nuclear layers were observed in the detached macula by optical coherence tomography. Then, he underwent successful scleral buckling guided by UBM. Three months later, the retina was flat with normal IOP, and the best corrected visual acuity of his left eye gradually improved to 20/25. UBM confirmed the closure of the tear. Conclusions Tear of the nonpigmented epithelium of the ciliary body is a rare condition associated with Schwartz-Matsuo syndrome. UBM plays a key role in detecting occult tears of the nonpigmented epithelium of the ciliary body, guiding scleral buckling surgery, and observing the closure of the tear postoperatively.

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“…Through UBM, the location and extent of granulomas in the ciliary body, pars plana, and peripheral retina in OT patients can be determined ( 27 ). Furthermore, UBM helps in observing complications involving the peripheral retinochoroidal structures in OT patients, such as ciliary detachment ( 27 , 28 ). Prior to surgery, UBM examination can assist surgeons in selecting appropriate PPV incision sites, avoiding contact with peripheral granulomas and preventing granuloma perforation-induced retinal break or retinal detachment ( 25 ).…”