Partial thickness sclerectomy and intravitreal anti-VEGF therapy for intractable uveal effusion syndrome.

PURPOSE: To report a case series of three patients with intractable uveal effusion syndrome (UES), treated with partial thickness sclerectomy and intravitreal anti-VEGF therapy. METHODS: Three patients with intractable UES were included. All patients underwent intravitreal anti-VEGF therapy to facilitate resolution of uveal effusion. The concentrations of IL-1ß, IL-6, IL-8, IL-10, IL-12p70, TNF and VEGF in aqueous humor were measured. RESULTS: After the last intravitreal injection, all three eyes had total resolution of the chorioretinal detachment or subretinal fluid. One eye experienced improvement in visual acuity. All patients were free from recurrence during the follow-up period. Aqueous IL-6, IL-8 and VEGF concentrations were elevated in all cases. CONCLUSIONS: Our current data provided the evidence that VEGF was increased in eyes with intractable UES and anti-VEGF therapy was effective, suggesting that partial thickness sclerectomy and intravitreal anti-VEGF therapy could be a new choice for intractable UES.

Uveal effusion syndrome ­ a case study. / Zespól wysiekowo-naczyniówkowy ­ opis przypadku.

We report a case study of a 63-year-old female admitted to our department with substantially decreased vision in her right eye. Bilateral uveal effusion syndrome concomitant with nanophthalmos was diagnosed. The patient received systemic treatment with non-steroidal anti-inflammatory drugs and underwent sclerectomy with topical application of mitomicin C. Gradual resolution of the retinal detachment leading to full reattachment was observed over the next 2 months. Retinal detachment did not reoccur in a long-term follow up.

Rheohaemapheresis.

The rheology of the blood as description of the flow characteristics approves conclusions to the perfusion of the different tissues. Many pathological processes influence the rheological qualities of the blood or the characteristics of the vessels, especially the capillaries. In both cases the perfusion of the tissue can be to a great extent disturbed. The rheological qualities of the blood can be ameliorated in different ways. Rheohaemapheresis is a very effective and save method to reduce high molecular plasma proteins. In the last decades in the meantime rheohaemapheresis was very successfully applied to treat age-related macular degeneration (AMD), idiopathic sudden hearing loss (ISHL), diabetic complications, coronary heart disease, small vessel disease, uveal effusion syndrome, central vein thrombosis of the eye and all other disorders of the microcirculatory system.

Evolving consensus on managing vitreo-retina and uvea practice in post-COVID-19 pandemic era.

The COVID-19 pandemic has brought new challenges to the health care community. Many of the super-speciality practices are planning to re-open after the lockdown is lifted. However there is lot of apprehension in everyone's mind about conforming practices that would safeguard the patients, ophthalmologists, healthcare workers as well as taking adequate care of the equipment to minimize the damage. The aim of this article is to develop preferred practice patterns, by developing a consensus amongst the lead experts, that would help the institutes as well as individual vitreo-retina and uveitis experts to restart their practices with confidence. As the situation remains volatile, we would like to mention that these suggestions are evolving and likely to change as our understanding and experience gets better. Further, the suggestions are for routine patients as COVID-19 positive patients may be managed in designated hospitals as per local protocols. Also these suggestions have to be implemented keeping in compliance with local rules and regulations.

Gyrate atrophy of the choroid and retina: amino acid metabolism and correction of hyperornithinemia with an arginine-deficient diet.

Four patients with gyrate atrophy of the choroid and retina were studied, all of whom exhibited the hyperornithinemia characteristic of this disorder. Elevated plasma histidine and diminished plasma lysine and branched-chain amino acids were also noted. The renal clearances of these four amino acids were not sufficiently elevated to explain their low plasma levels. In one subject, an arginine-deficient diet led to progressive reduction in plasma ornithine from 13 times normal to the upper limits of normal, along with the disappearance of ornithinuria and lysinuria. Orally administered alpha-aminoisobutyric acid facilitated the fall in plasma ornithine by increasing renal losses of ornithine. It also increased the clearances of most other amino acids. When plasma ornithine approached normal (less than 200 microM), plasma lysine became normal, plasma arginine became subnormal, and renal clearances of basic amino acids decreased. Long-term (1.5 yr) maintenance with a diet containing 10-20 g of protein plus essential amino acids served to keep plasma ornithine at between 55-355 microM; chorioretinal degeneration did not progress and vision apparently improved.

[Uveal effusion syndrome after strabismus surgery]. / Síndrome de efusión uveal secundario a cirugía de estrabismo.

CASE REPORT: A woman was operated on for strabismus under topical anesthesia. An exudative conjunctivitis was diagnosed immediately after the surgery, and a uveal effusion syndrome diagnosed 15 days later. Surgery exploration, vycril suture removal and therapy with systemic, sub-tenon, and topical corticosteroid and antibiotics was initiated. Intraoperative culture revealed evidence of Staphylococcus epidermidis. Good resolution occurred in 4 months. DISCUSSION: Uveal effusion secondary to strabismus surgery has not been reported in the published literature. Implant and suture infection by Staphylococcus epidermidis following scleral buckling surgery may be a possible, but rare, cause of the uveal effusion syndrome.

Uveal Effusion: Clinical Features, Management, and Visual Outcomes in a Retrospective Case Series.

PURPOSE: To present the experience of a tertiary care ophthalmic institution in the assessment and management of uncommon causes of uveal effusion and related complications. MATERIALS AND METHODS: A retrospective chart review was conducted of 12 patients diagnosed with uveal effusion and managed at our institution between 1996 and 2012. The presenting features, investigations, management, and outcomes were analyzed for each case. RESULTS: The case series encompasses a variety of clinical conditions that cause uveal effusion including inflammatory, hydrostatic, and idiopathic mechanisms. Two thirds of the patients presented with secondary angle closure. Half of the patients had serous retinal detachment. Modern imaging techniques including ultrasound biomicroscopy and high-resolution magnetic resonance imaging were critical in making the diagnosis. Seven of the 12 patients responded to medical treatment and 4 required scleral surgery. Uveal effusions resolved in all patients after treatment. CONCLUSIONS: Uveal effusion is a complex and poorly understood clinical entity with significant visual morbidity and is caused by a range of ocular and systemic diseases. Effective management is critically dependent on the underlying cause.

Current concepts in the treatment of vitreous block, also known as aqueous misdirection.

Vitreous block (VB), a rare secondary angle-closure caused by anterior rotation of the ciliary body, occurs in a variety of settings, but most frequently after glaucoma filtering surgery. The etiology remains unclear, but choroidal expansion and anterior vitreous abnormalities have been proposed. In the past, treatment of VB has yielded high rates of failure and recurrence. Advancements in surgical techniques, however, have led to improved visual outcomes. We review the history of this condition and present a stepwise approach to its diagnosis and treatment using modern imaging modalities and surgical techniques.

Neovascularization of the iris (rubeosis iridis).

This is a review of neovascularization of the iris and the neovascular glaucoma that often follows. With the aging of our population, this has become a more frequent cause of blindness and enucleation of eyes. Iris neovascularization is never primary, but is always secondary to other ocular disorders. The pathology is described based on the study of 110 globes. Diagnosis, pathogenesis and treatment are discussed.

Metastatic disease from untreated uveal melanomas.

Few ophthalmologists or pathologists have observed uveal melanomas that metastasized before they were recognized and treated. In an effort to characterize those melanomas that have produced metastatic disease before the tumor-containing eye was enucleated, we have collected a series of 29 cases for review. These have generally involved older subjects (median age 65 years) who had large tumors that had been symptomatic for long periods before being recognized. A disproportionately large percentage showed extraocular extension. Although the data support the thesis that uveal melanomas are typically slow-growing tumors that show local infiltrative properties but little tendency to produce metastatic disease unless treated by enucleation of the eye, it is possible that the available information is possibly biased by our methods of acquisition of data. Much pertinent information is lost because the cases usually do not come to the attention of ophthalmologists or ophthalmic pathologist. This missing link in our knowledge of the natural course of untreated uveal melanomas is one of several factors that make it impossible to determine whether the overall effects of enucleation have been beneficial or harmful in the management of this disease.

Suprachoroidal hemorrhage after glaucoma filtering surgery.

We reviewed a series of 305 consecutive glaucoma filtering procedures performed by one surgeon. Five eyes (1.6%) had a postoperative suprachoroidal hemorrhage. All five eyes were aphakic, and four had undergone a partial or complete vitrectomy before the glaucoma surgery. The incidence of this complication was 13% (five of 37) among the aphakic eyes and 33% (four of 12) in the aphakic, vitrectomized eyes in this series. Despite drainage of the hemorrhage and reformation of the anterior chamber, three patients had a poor visual outcome.

Therapeutic ultrasound in the production of ocular lesions.

After testing high intensity focused ultrasound on ocular tissues in animals, to obtain damage threshold equations, we used ultrasound for ocular therapy in experimental animals. We developed a therapeutic system for use in conjunction with a low=energy diagnostic ultrasound visualization technique. Our system included a spherical focused transducer operated at a frequency of 9.8 MHz to produce a focal spot 9 cm from the transducer surface. This technique produced controlled ocular tissue damage similar to that produced by laser and xenon are photocoagulation. It can be used to treat any level of tissue, ocular or orbital, and does not require media clarity. Specific tissue absorption properties necessary for laser damage were not required to produce the desired damage.

Treatment of traumatic cyclodialysis with vitrectomy, cryotherapy, and gas endotamponade.

An aphakic patient with severe chronic hypotony had an alternative treatment of a traumatic cyclodialysis cleft: a 3-port pars plana vitrectomy, cryotherapy of the cleft, and fluid-gas exchange with subsequent supine positioning. The therapeutic principle was mechanical apposition of the detached ciliary muscle to the scleral spur by the gas bubble and scar induction by cryotherapy. Intraocular pressure increased to within normal ranges, and visual acuity improved over a 15 month follow-up.

Sodium hyaluronate for postoperative aphakic choroidal detachment.

Collapse of the anterior chamber, choroidal and ciliary body detachments and ocular hypotony developed without explanation 2 weeks after uneventful intracapsular cataract extraction in a 60-year-old woman. Following an unsuccessful attempt to maintain an adequate chamber depth with air, sodium hyaluronate was injected into the chamber after surgical drainage of suprachoroidal fluid, allowing for spontaneous recovery of aqueous production while protecting the anterior segment from the ravages of chamber collapse.

The natural course of active choroidal lesions in the presumed ocular histoplasmosis syndrome.

Eighty-two patients and 106 eyes with the POHS have been followed for one year or longer. Untreated active choroidal lesions were divided into groupings based on the distance from the center of the CFZ and the reltionship to the border of the CFZ. Twenty-three percent of untreated active choroidal lesions that were located inside the CFZ achieved 20/20 to 20/40 vision. Sixty-three percent of untreated active choroidal lesions that were located outside of the CFZ achieved a vision of 20/20 to 20/40. The active choroidal lesions with the best visual prognosis were 0.25 to 0.5 disc diamterers, demonstrated no growth, and had little or no associated choroidal bleeding. Activation of choroidal lesions in the fellow eye at the site of preexisting atrophic scars was documented in 21% of the eyes. One fellow eye developed a de novo active choroidal lesion. Eighteen percent of the cases had structurally congested nerve heads characterized by slight elevation of the disc and no physiologic depression; 3% of the eyes had drusen of the optic nerve. A relationship may exist between peripapillary scarring in the POHS and these nerve head changes.

Bilateral diffuse uveal melanocytic proliferation with multiple iris cysts.

IMPORTANCE: Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare paraneoplastic syndrome with characteristic findings, including exudative retinal detachment, rapid cataract formation, and uveal melanocytic tumors. We report a case notable for bilateral iris and ciliary body cysts--a rare presentation of the disease. OBSERVATIONS: A woman in her 50s presented with bilateral decreased vision. Her medical history was significant for clear cell adenocarcinoma of the endometrium. Slitlamp examination revealed a contiguous ring of pigmented translucent iris cysts at the pupillary margin of each eye, confirmed with ultrasound biomicroscopy. Ophthalmoscopic examination of the left eye showed a geographic patch of subretinal fluid temporal to the macula that was associated with orange polygonal pigment. The patient underwent periocular injection of triamcinolone acetonide, with resolution of the subretinal fluid. Recurrent fluid was treated successfully with a second injection of triamcinolone. CONCLUSIONS AND RELEVANCE: Our case of BDUMP appears to be the first to demonstrate multiple iris and ciliary body cysts with high-quality color photography and ultrasound biomicroscopy. Involvement of the anterior uveal tract may be more common than reported in the literature because of its occult nature. Ultrasound biomicroscopy and anterior segment optical coherence tomography may be useful in patients with suspected BDUMP to identify anterior uveal tract involvement.