Treatment of postoperative uveal effusion in a
nanophthalmic patient with posterior sub-Tenon’s
Nanophthalmos is characterised by small, hypermetropic
eyes and thickened sclera. Patients frequently develop
glaucoma and primary uveal effusions (PUEs).
Postoperative complications are common.1,2We describe
the successful treatment of secondary uveal effusions
(SUEs) in a nanophthalmic patient with posterior
sub-Tenon’s triamcinolone (PSTT).
A 72-year-old Caucasian man was referred with raised
IOP (40mmHg OD, 30mmHg OS). Visual acuity was
6/9 bilaterally (þ7.00 DS). Gonioscopy demonstrated
open angles (Shaffer grade 1, 901; grade 2, 2701) with
normal anatomy. Central AC depth was 2.0mm (A-scan
measurement inclusive of corneal thickness). Medical
treatment failed to control IOP OD, and he underwent
uncomplicated trabeculectomy. Postoperatively he
developed a large SUE (IOP 20mmHg, PI patent, AC
shallow, bleb well-formed). Ultrasonography
demonstrated thickened sclera with significant SUE
(Figures 1 and 2), axial length 20mm. Aqueous
misdirection was excluded and nanophthalmos
diagnosed. The SUE resolved initially with topical
steroids, atropine, and oral acetazolomide (Figure 3).
A recurrence required surgical drainage. A further, later,
painful recurrence with dilated episcleral vessels was
resolved following administration of oral prednisolone
40mg. Gastric ulceration necessitated discontinuation
with recurrence of SUE. PSTT 40mg was subsequently
successful with sustained effect. Later, cataract surgery
was followed by SUE, responding rapidly to repeat PSTT.
Final IOP was 20mmHg (angle open but pigmented,
cup:disc ratio 0.7).
Nanophthalmic patients frequently develop SUE
following surgery,3and it is therefore helpful to be aware
of the diagnosis preoperatively. Various strategies have
been proposed, from conservative management to
surgical drainage.4Oral steroids can be effective.
Deep sclerectomy, sclerotomy, intravitreal triamcinolone,
and bevacizumab have been described.4,5
Here, trabeculectomy alone was appropriate, owing to
the absence of cataract and open angle. In combined
procedures, the higher cataract complication rate may
compromise trabeculectomy success.
Differences may exist in pathophysiology of PUE and
SUE. PUE is thought to result from increased resistance
to uveoscleral outflow in thickened sclera through
impedance of episcleral venous drainage. Surgical
drainage is frequently indicated for PUE. SUE may have
an inflammatory component. Perhaps, nanophthalmic
eyes cannot compensate for increased circulation and
exudation accompanying surgical inflammation,
explaining an apparent role for steroids.
We have described repeatable SUE resolution
following PSTT. Potential secondary IOP elevation
should be considered. We propose that this novel
approach offers a safe, effective management alternative
and also a simple mode of surgical prophylaxis.
Fundus photograph of secondary uveal effusions.
B-scan showing SUVs and thickened sclera.
B-scan showing resolveduveal effusionsand
Eye (2011) 25, 528–536
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