First Author: A.Gorro-Miro SPAIN
Co Author(s): F. Ramos-Marti A. Montoliu-Anton E. Etxabe-Agirre R. Banon-Navarro
Back to previous
Idiopathic uveal effusion syndrome (IUES) is caused by a histochemical disorder in the sclera that produces a malfunction in the ocular venous drainage, this leads in disorders in nearly every ocular structure. The presumption diagnosis is clinical and the treatment options are limited with few described successful cases and a controverted management. We describe a case of IUES in order to give evidence of outcome in our patient.
Hospital General Universitario de Castellón
Case report. Patient monitored with optical coherence tomography and ocular B-scan ultrasound imaging. Treated with scleral surgery.
A 50 year-old male, with chronic bronchitis, came to ophthalmology emergency room with red right eye (OD) and visual acuity (VA) 0.3 LogMAR. In the biomicroscopy of OD there was dilated episcleral veins, narrow anterior chamber, intraocular pressure of 32 mmHg, papilla edema and 360º serous peripheral retinal detachment (RD) that partially affected the macula with cystic macular edema. There was not any other remarkable finding. The left eye was normal. The B-scan ultrasonography showed a 360º ciliary body detachment. The axial length was normal. Orbital nuclear magnetic resonance and angio-computed tomography was performed and an arterio-venous fistula or any other compressive mass was ruled out; an OD little thickened sclera was described. The corticosteroid treatment worsened the serous RD and the VA diminished. We opted for surgical treatment (4 rectangular scleral flaps of 6 x 4 mm of 2/3 thickness, anterior to the equator) to improve the vortex vein drainage with little success.
IUES results in a challenging diagnosis and treatment. In our case, corticosteroids worsened the symptoms and signs, and the surgery was insufficient. Other publications describe more aggressive treatments (4 scleral flap of 2/3 thickness 4x5mm with scleral excision of 3x4mm exposing the choroid, Ex-PRESS shunt inserted obliquely in the sclerotomy), some with better success. More publications and new therapeutic strategies addressed to increase the venous drainage would be necessary to reach an IUES management consensus.