CLINICAL CHARACTERISTICS, TREATMENT MODALITIES, AND THEIR ASSOCIATION WITH LONG-TERM VISUAL OUTCOMES IN UVEAL EFFUSION SYNDROME.

PURPOSE: Uveal effusion syndrome (UES) is a rare eye condition characterized by fluid accumulation in the uveal layer. We investigated its clinical characteristics and treatment modalities and their association with long-term visual outcomes. METHODS: This retrospective cohort study included patients with UES treated at two tertiary hospitals between November 2005 and June 2023. Clinical characteristics and treatment outcomes by modality were compared between nanophthalmic Type 1 UES (UES-1) and non-nanophthalmic Type 2 UES (UES-2), and between initial and final visits. Logistic regression analysis was used to identify factors associated with vision loss. RESULTS: Twenty-three eyes were included (UES-1, n = 10; UES-2, n = 13). Retinal pigment epithelium mottling was significantly more common in UES-1 than in UES-2 ( P = 0.043); no other between-group differences were observed. Post-treatment, in UES-1, best-corrected visual acuity ( P = 0.028) and central macular thickness ( P = 0.046) significantly decreased; in UES-2, best-corrected visual acuity significantly improved ( P = 0.021), and subfoveal choroidal thickness ( P = 0.048), central subretinal fluid height ( P = 0.011), and central macular thickness ( P = 0.010) significantly decreased. UES-2 was associated with a lower risk of vision loss (odds ratio, 0.024; P = 0.044). No other associated factors were identified. CONCLUSION: The UES type was the sole independent prognostic factor for vision loss, whereas treatment modalities had no significant impact on visual outcomes.

A Novel Method for Transillumination.

PURPOSE: To introduce a cost-efficient device for transillumination in the management of uveal melanoma. METHODS: Todorich Illuminated Depressor is a ball-point depressor, designed to work with the 23-, 25- and 27-gauge Alcon Constellation endoillumination. It was invented to allow indentation and peripheral vitreous visualization for vitrectomy. RESULTS: Todorich depressor combined with endoillumination can also work as a device for transillumination for tumor localization. We started using this method of transillumination for the management of uveal melanomas since September 2020 and have successfully performed Ru-106 plaque brachytherapy for 10 cases of uveal melanoma. Three were large choroidal melanoma cases, and en bloc tumor resection by partial lamellar sclerouvectomy was successfully performed after precise localization of tumors using this method. CONCLUSION: Alcon Constellation endoillumination capped with Todorich Illuminated Depressor is an affordable and viable alternative for transillumination of intraocular tumors.

Clinical Features and Multimodal Imaging Findings of Focal Scleral Nodule: Potential Association between Lesion Characteristics and Age.

OBJECTIVE: To describe the clinical course and anatomic features of focal scleral nodules (FSNs) based on their clinical characteristics and multimodal imaging findings and analyze their potential associations with the patient's age. DESIGN: Single-center, retrospective, observational case series. SUBJECTS: Twenty-three lesions of 23 patients with FSN. METHODS: Clinical characteristics were analyzed, and multimodal imaging was performed, including color fundus photography, OCT, fundus autofluorescence imaging, near-infrared imaging, B-scan ultrasonography, fluorescein and indocyanine green angiography, and OCT angiography of FSNs. MAIN OUTCOME MEASURES: Qualitative features, including the slope of anterior curvature (curvature of the dome shape is less than nodular curvature, which is less than volcanic curvature; i.e., volcanic curvature has the steepest slope), retinal pigment epithelium (RPE) status, and fluid compartments, were analyzed. Quantitative measurements, including maximum linear basal diameter, maximum horizontal length at the choroidoscleral border, maximum vertical length (Vmax) from the choroidoscleral border, and choroidal thickness, were analyzed. RESULTS: The mean age at presentation was 44 ± 17 years (range, 4-68 years), and the mean follow-up duration was 32.2 ± 29.5 months. On OCT, all lesions were confined to the sclera. Patients with volcanic or nodular anterior curvature were younger than those with the dome-shaped phenotype (35 ± 19 years vs. 52 ± 9 years, respectively; Mann-Whitney U test; P = 0.015). The Spearman rank correlation analysis displayed a significant correlation between age at diagnosis and Vmax (r = -0.466; P = 0.025). The Wilcoxon matched paired t test for the patients demonstrated a significant decrease in Vmax at the final follow-up visit (initial, 555 ± 228 µm vs. final, 517 ± 202 µm, respectively; P = 0.028). We observed subretinal fluid, intraretinal fluid, pigment epithelial detachment, and severe outer retinal atrophy in a relatively older population with sustained nodular or volcanic anterior curvature (age, 52 ± 7 years; range, 43-60 years). One lesion diagnosed in a patient aged 4 years demonstrated spontaneous regression. CONCLUSIONS: Young patients tended to have protruded lesions (high Vmax) with nodular or volcanic anterior curvature. Older patients manifested the dome-shaped phenotype, and those with sustained nodular or volcanic curvature tended to develop fluid compartments or atrophic changes of the overlying RPE and retina because of possible chronic mechanical compression. Thus, there could be a significant association between FSN phenotype and age.