Uveal effusion syndrome in 104 eyes: Response to corticosteroids – The 2017 Axel C. Hansen lecture

Abstract

Purpose:The purpose of the study was to investigate the corticosteroids for uveal effusion syndrome (UES).Methods:Retrospective series of 104 eyes with UES treated with oral corticosteroids (OCS), periocular corticosteroids (PCS), topical corticosteroids (TCS), or observation (OBS). Main outcome measure was UES resolution.Results:Of 104 eyes, treatment included OCS (n = 27), PCS (n = 12), TCS (n = 11), and OBS (n = 54). A comparison of the four groups (OCS vs. PCS vs. TCS vs. OBS) revealed differences in those managed with OCS versus OBS as younger (66 vs. 72 years, P = 0.049), PCS versus OBS as male (100% vs. 54%, P = 0.002), PCS versus OBS with decreased visual acuity (VA)/visual field (91% vs. 51%, P = 0.018), and OBS versus OCS as asymptomatic (28% vs. 0%, P = 0.001). Of the 59 with follow-up information, management included OCS (n = 21), PCS (n = 12), TCS (n = 6), and OBS (n = 20). There were differences in initial VA <20/400 in PCS versus OBS (42% vs. 5%, P = 0.018), effusion thickness in TCS versus OCS (7 vs. 3 mm, P = 0.004), and serous retinal detachment in PCS versus OBS (100% vs. 30%, P < 0.001) and PCS versus OCS (100% vs. 57%, P = 0.012). Regarding outcomes, VA showed less worsening in OCS versus OBS (0% vs. 30%, P = 0.008) and OCS versus PCS (0% vs. 33%, P = 0.012). There was no difference in rate of effusion resolution or effusion recurrence. Overall, using combination of corticosteroid therapies, effusion resolution was achieved in 56/59 (95%) cases and the need for surgical management with scleral windows was necessary in only 3/59 (5%) cases. Complications included cataract (n = 9) and no instance of steroid-induced glaucoma.Conclusion:Management of UES is complex and depends on disease severity. Using various corticosteroid delivery routes, UES control was achieved in 95%, and scleral window surgery was required in only 5%. A trial of corticosteroids can benefit patients with UES.

Comparing the Results of Vitrectomy and Sclerectomy in a Patient with Nanophthalmic Uveal Effusion Syndrome

“…UES may be difficult to diagnose as it may mimic many entities. Shields in his study on 104 eyes reported a mean age of 70 years [ 10 ]. However, the study specifically evaluated Type 3 UES with normal sclera using ultrasound or MRI.…”

“…The most commonly used treatment is surgery involving the creation of surgical sclerostomies (scleral window surgery) or partial thickness sclerectomies to support transscleral drainage [ 1 , 8 , 9 ]. In some cases, steroids or NSAID may be effective [ 10 , 11 ].…”

long term follow up of cases of uveal effusion syndrome treated with partial thickness sclerectomies

“…Some ophthalmologists tried medical treatment for uveal effusion syndrome with oral steroid. Shield et al treated 104 eyes of uveal effusion syndrome with corticosteroids 17 Bausili et al used CO2 laser 18 and control was achieved in 95% cases in reports but according to others, surgical treatment was only effective option for treatment of idiopathic uveal effusion syndrome. We have found that surgical sclerectomies using partial thickness resection was very effective.…”

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

“…In 1963, Schepens and Brockhurst first reported uveal effusion syndrome (UES) in which they described the pathology as choroidal detachment, often with secondary retinal detachment, optic disc swelling, and minimal signs of uveitis [13].…”