Supraciliary Effusion Research Articles

Uveal Effusion Syndrome Due to WNT10A Mutation.

Uveal effusion syndrome (UES) is an exudative detachment of ciliary body, retina and choroid. Various underlying causes leads to UES-like drugs (topiramate), inflammation and hypotony. Wnt gene involvement has never been associated with UES. We report a case of bilateral UES being misdiagnosed as Vogt-Koyanagi-Harada syndrome (VKH), with Wnt gene dysfunction as the underlying trigger. A 32-year-old male presented with diminution of vision in his left eye. He was found to have choroidal detachment with retinal detachment in his left eye. Choroidal detachment was noted in the right eye. Various ocular imaging including fundus fluorescein angiography and ocular coherence tomography was done. He was misdiagnosed as a case of VKH syndrome, for which he was treated with systemic immunomodulatory therapy. However, a subclinical response was made to revisit the diagnosis. Ultrasound biomicroscopy showed supraciliary effusion. Systemic and genetic evaluation led to the detection of Wnt10A pathway mutation. UES is an entity of diagnostic challenge. Careful and thorough systemic evaluation is required to clinch the diagnosis. We reported the first case of bilateral UES recalcitrant to corticosteroids, with Wnt10A gene mutation.

Ab interno canaloplasty versus gonioscopy-assisted transluminal trabeculotomy in open-angle glaucoma: a randomised controlled trial

ObjectiveTo compare the efficacy and safety of ab interno canaloplasty (ABiC) with gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma (OAG).MethodThis randomised clinical trial recruited eyes with OAG and...

Acetazolamide –friend to foe

Bilateral acute angle closure attacks are rare and usually secondary to drugs or concurrent microspherophakia. Acetazolamide, a sulphonamide medication used in controlling intraocular pressure, is known to cause uveal effusion precipitating secondary acute angle closure attack. Here we report a well-documented case of concurrent bilateral angle closure with shallowing of the anterior chamber, supra-ciliary effusion, and serous and hemorrhagic choroidal detachment after administration of oral acetazolamide that resolved on withdrawing the insulting agent.

Qualitative ultrasound biomicroscopy in glaucoma.

UBM is a high-resolution ultrasound technique which allows non-invasive, in vivo imaging of the anterior segment and iridocorneal angle. This video is compilation of short video clips and images which gives description on identification of angle closure due to pupillary block, peripheral anterior synechiae, iris bombe, plateau iris, supra ciliary effusion, and malignant glaucoma. It also shows video demonstrating partially and fully patent iridotomy and features of trabeculectomy bleb. Synopsis: This video summarizes importance of UBM application in angle closure glaucoma to understand its pathophysiology by showing the relationship between the peripheral iris, trabecular meshwork and ciliary processes. UBM provides two-dimensional, grayscale images of the angle structures and allows identification of non-pupillary block mechanism in angle closure glaucoma, which can be recorded for qualitative and quantitative analyses. https://youtu.be/prsmGnR8jYc.

Clinical presentation and treatment outcomes of an algorithmic approach to uveal effusion syndrome.

To describe the clinical features and treatment outcomes in spontaneous uveal effusion syndrome (UES). A 10-year retrospective chart review of UES patients from a tertiary eye center was carried out. Optical coherence tomography (OCT), fundus fluorescein angiography, and ultrasound biomicroscopy (UBM) scans were performed. UES was managed based on presenting best-corrected visual acuity (BCVA), symptoms, and fundus findings. Patients with secondary causes of uveal effusion were excluded. Twenty-five eyes of 16 patients were included. Of the 16 patients, 14 (88%) were male and 9 (56%) had bilateral disease. Fifteen of 25 affected eyes had nanophthalmos (axial length (AL) <20.5 mm) and 6 had hyperopia with AL >20.5 mm. The presenting mean distance BCVA was 0.74 ± 0.64 logMAR (mean Snellen: 20/100). Eleven eyes had exudative retinal detachment, and 4 also had exudative choroidal detachment (CD). Choroidal thickness (CT) was increased in 11 eyes on B-scan ultrasonography, and the mean CT was 1.74 ± 0.38 mm. Sub-retinal fluid (SRF) and retinal folds were the most common OCT findings. UBM findings included shallow angles, peripheral CD, and supra-ciliary effusion. A combination of local and systemic corticosteroids was used to successfully treat 12 eyes, 6 needed surgery, and 7 were observed. Partial sclerectomy with anterior chamber maintainer-assisted SRF drainage was the favored surgery. The median period of follow-up was 6.5 months (0.1-76 months), and the mean distance BCVA at the last follow-up was 0.58 ± 0.42 logMAR (mean Snellen: 20/80). UES can be suitably managed both medically and surgically based on clinical presentation.

Ultrasound biomicroscopy as a tool in the evaluation and management of ocular hypotony in uveitis.

Purpose:Chronic uveitis can lead to hypotony that may result in severe visual impairment. We highlight the use of ultrasound biomicroscopy (UBM) as an imaging tool to decide the modality of therapy and management of uveitic hypotony.Methods:This was a retrospective hospital-based interventional case-series study that included a total of 36 eyes of 25 patients with uveitic hypotony seen between January 1997 and January 2020.Results:Thirty-six eyes of 25 patients with uveitic ocular hypotony were included. Unilateral involvement was seen in 56%. The median age of presentation was 21 years with a median follow-up of 21.5 months. Anterior uveitis was noted in 13.88%, intermediate uveitis in 52.77%, and panuveitis in 33.33% eyes. UBM findings commonly noted were pars plana membranes, supraciliary effusion, blunted ciliary process, and ciliary body traction. Other findings included ciliochoroidal detachment and ciliary body edema. Moreover, 22.2% eyes were managed with medical therapy alone, whereas 77.8% eyes received both medical and surgical intervention based on UBM findings. Furthermore, 66.7% eyes showed improvement in intraocular pressure, 13.9% eyes maintained the same IOP, whereas 19.4% eyes had worsening of IOP at final follow-up.Conclusion:We found UBM as a useful imaging tool in evaluating and judiciously deciding the mode of management of uveitic hypotony.

Low-dose transscleral cyclophotocoagulation with subsequent phacoemulsification in the treatment of prolonged acute primary angle closure

BackgroundTo explore the outcomes and mechanisms of intraocular pressure (IOP) control using low-dose transscleral cyclophotocoagulation (LDTSCP) followed by phacoemulsification in patients with prolonged acute primary angle closure (APAC).MethodsPatients with prolonged...

Interleukin‐1 blockade in neuro‐Behçet's disease: a case‐based reflection

Interleukin‐1 blockade in neuro‐<scp>B</scp>ehçet's disease: a case‐based reflection

Indapamide-induced transient myopia with supraciliary effusion: case report

BackgroundIngestion of sulphonamide-derived drugs has been reported to possibly have ocular side-effects. Authors aimed to present a rare case of indapamide-induced transient myopia with ciliary body edema and supraciliary effusion.Case presentationA 39 years old caucasian female patient presented at the Department of Neurology with headache and sudden bilateral loss of distant vision. Neurological assessment and cranial CT scans were unremarkable. For her hypertension, twice a day bisoprolol 2.5 mg and once a day indapamide 1.5 mg tablets were prescribed several days before. At her presenting, ophthalmic findings were as follows: visual acuity 0.08-7.25Dsph = 1.0 and 0.06-7.25Dsph = 1.0; IOP 25 mmHg and 24 mmHg, anterior chamber depth (ACD) 2.32 mm and 2.49 mm, lens thickness (L) 4.02 mm and 4.09 mm in the right and the left eye, respectively. By means of ultrasound biomicroscopy (UBM), thickened (720 / 700 micron) and detached ciliary body, its forward movement (ciliary body-cornea angle 108′ / 114′) and forward rotated ciliary processes were seen. Angle opening distance (AOD500) were 300 / 314 microns. By the following days, the myopia gradually diminished, and a week after her first symptoms, her uncorrected visual acuity was 1.0 in both eyes, IOP 13 mmHg and 17 mmHg, ACD 3.68 mm and 3.66 mm, L 3.78 mm and 3.81 mm in the right and the left eye, respectively. Ciliary body edema and detachment disappeared (ciliary body thickness 225 / 230 micron), both of the ciliary body-cornea angle 134′ / 140′ and the AOD500 (650 / 640 microns) increased. At this point, the patient admitted that she had stopped taking indapamide two days before.ConclusionsOur case report is the third one in the literature to present indapamide-induced transient myopia, and the first to employ UBM for describing the characteristics of this rare condition. According to the findings, authors suggest that both ciliary muscle contraction and ciliary body edema may play role in the pathomechanism. UBM seems to be a useful tool in the differential diagnosis of acute myopia. Further, authors wish to draw attention to one of the potential adverse effects of this drug which was not listed by its package insert.

Acute bilateral angle closure glaucoma induced by methazolamide

PurposeTo report a case of bilateral acute myopia and angle closure glaucoma after ingestion of methazolamide.MethodsAn interventional case report of a 70-year-old male who developed bilateral, acute myopia and angle closure glaucoma after ingesting methazolamide tablets for the treatment of normal tension glaucoma.ResultsBilateral anterior chamber shallowing associated with ciliary body edema, supraciliary effusions, and shallow posterior choroidal effusions were documented with slit-lamp photography and high-frequency ultrasonography. Near complete resolution of these signs after discontinuation of methazolamide were also documented.ConclusionMethazolamide may be associated with secondary myopia and angle closure glaucoma. Discontinuation of methazolamide leads to resolution of this process, as documented by slit-lamp photography and high-frequency ultrasonography.

Angle closure glaucoma associated with venlafaxine treatment

AbstractPurpose Despite its very weak anticholinergic profile, there are few case reports linking venlafaxine treatment with angle closure glaucoma. One of the principal pathophysiological mechanisms suggested is through supraciliary effusions.Methods We report a case of an 86 year old patient who presented with progressive symptoms of angle closure glaucoma in her left eye. Venlafaxine treatment had been started one week prior to presentation. Intraocular pressures were initially 22 mmHg in the right eye and 59 mmHg in the left eye. Ultrasound biomicroscopy (UBM) and gonioscopic exams were performed to better identify the pathophysiologic mechanism of her glaucoma.Results Gonioscopy demonstrated a closed angle in the left eye and a narrow angle in the right eye. Venlafaxine was discontinued and an anti‐glaucomatous treatment was started. There was bilateral resistance to 2% pilocarpine at presentation which subsided 48 hours after venlafaxine cessation. UBM demonstrated a plateau iris configuration with absence of supraciliary effusions.Conclusion To our knowledge, this is the first case describing angle closure glaucoma associated with venlafaxine treatment, where there is a documented bilateral resistance to pilocarpine and an UBM demonstrating a plateau iris configuration with absence of ciliary body effusions. These findings suggest a mydriatic mechanism for our patient’s glaucoma. The weak anticholinergic properties and the noradrenergic effect associated with venlafaxine could precipitate angle closure glaucoma without supraciliary effusions in a patient who is at risk for this condition.

106Ruthenium brachytherapy for ciliary recurrence with supraciliary effusion in retinoblastoma

Purpose: A 2-year-old boy with syndromic bilateral retinoblastoma resulting from a (del(13)(q12.3q14.3)) developed a recurrent tumor measuring 2.3X2.3mm at the ora serrata 15 months following last treatment.Methods: Ultrasound biomicroscopy (UBM) revealed a mass invading the ciliary body 6.6 mm in diameter associated with a localized supraciliary effusion.Results: Complete tumor regression was achieved 1 month after brachytherapy with a 106Ruthenium plaque. There was no recurrence at 16 months.Conclusion: This is the first clinical demonstration of supraciliary effusion in recurrent retinoblastoma. Brachytherapy appears to be effective in the treatment of this type of recurrence.

Morphologic Changes in the Anterior Segment in Patients with Initial-onset or Recurrent Vogt-Koyanagi-Harada Disease

Purposes: To investigate morphologic changes in anterior segments based on inflammatory phases of Vogt-Koyanagi-Harada (VKH).Methods: The author recruited 76 consecutive eyes of 38 patients with initial-onset VKH and 52 eyes of 26 patients with recurrent VKH. Morphologic changes in anterior segments were measured by ultrasound biomicroscopy (UBM). UBM parameters and intraocular pressure (IOP) were compared between two groups.Results: Ciliary thickness and area significantly increased in the recurrent group compared with the initial-onset group. Twelve patients (31%) in the initial-onset group showed supraciliary effusions, but no patients in the recurrent group had supraciliary effusions. Angle opening and anterior chamber depth were significantly decreased in the initial-onset group compared with the recurrent group. High IOP > 30 mmHg was found in 7 patients with initial-onset disease, while low IOP < 10 mmHg was detected in 6 patients with recurrent disease.Conclusions: The results indicate that morphologic changes associated with IOP alterations depend on inflammatory phases of VKH disease.

Morphologic changes in the anterior segment after phacovitrectomy for proliferative diabetic retinopathy

To determine whether combined phacoemulsification and intraocular lens implantation with pars plana vitrectomy (PPV) (phacovitrectomy) in patients with proliferative diabetic retinopathy (PDR) causes morphologic changes in the anterior segment and to evaluate whether there is a relationship between the anatomic changes and inflammatory complications. Department of Ophthalmology, Chonnam National University Hospital, Gwangju, South Korea. Patients who had uneventful surgery for PDR were divided into 2 groups (phacovitrectomy and PPV only). Morphologic changes in the ciliary regions were measured by ultrasound biomicroscopy (UBM) 1 day before surgery and 1, 2, 3, 5 days, 2 weeks, 1 and 2 months after surgery. The UBM parameters and inflammatory complications in the 2 groups were compared. The study comprised 60 patients; 30 had phacovitrectomy and 30, PPV only. The frequency of supraciliary effusions was higher in the phacovitrectomy group (24/30, 80%) than in the PPV-only group (14/30, 46%) (P = .015). The decrease in angle opening and anterior chamber depth was more prominent after phacovitrectomy. The incidence of complications was higher in the phacovitrectomy group than in the PPV-only group (60% versus 30%, abnormal intraocular pressure; 30% versus 7%, intraocular fibrin and posterior synechia formation); the complications were associated with supraciliary effusions. The results indicate that phacovitrectomy for PDR may induce more morphologic changes in the anterior segment. Supraciliary effusions were associated with inflammatory complications. Appropriate control of postsurgical inflammation is necessary in phacovitrectomy for PDR.

Intravitreal Triamcinolone Reduces the Morphologic Changes of Ciliary Body After Pars Plana Vitrectomy for Retinal Vascular Diseases

To investigate the early postoperative changes in ciliary body after pars plana vitrectomy (PPV) for retinal vascular disease and to determine whether intravitreal triamcinolone acetonide (IVTA) affects postvitrectomy changes of the ciliary body. Prospective interventional case-control study. We recruited 46 patients who underwent uncomplicated PPV for retinal vascular disease (35 with proliferative diabetic retinopathy (PDR) and 11 with branch retinal vein occlusion) and divided the patients into two groups according to the use of IVTA at the end of the PPV. The morphologic changes of the anterior segments were measured by ultrasound biomicroscopy (UBM) one day before and one day, two days, three days, five days, two weeks, one month, and two months after the PPV. The main outcome measures were the thickness and area of the ciliary body, the frequency of supraciliary effusions (SEs), angle-opening, and anterior chamber depth (ACD). We compared the UBM parameters between the two groups. The thickness and area of the ciliary body significantly increased from day 1 to day 5 postoperatively. Nineteen of 46 eyes had SEs that were frequently associated with divergent alterations of postoperative intraocular pressure (IOP). The angle-opening and ACD were significantly decreased and dependent upon the findings of ciliary body thickness and SEs. The degree of the morphologic changes of the ciliary body and the frequency of SEs were significantly lower and of shorter duration in the IVTA group compared to the non-IVTA group. The PPV for retinal vascular disease induces the morphologic changes of the ciliary body associated with postoperative abnormalities in IOP during the early postoperative period. Administration of IVTA at the end of the PPV effectively reduces or shortens the duration of the postvitrectomy changes of the ciliary body.

Correction: Bilateral acute angle closure caused by supraciliary effusions associated with venlafaxine intake

Correction: Bilateral acute angle closure caused by supraciliary effusions associated with venlafaxine intake

Bilateral acute angle closure caused by supraciliary effusions associated with venlafaxine intake

Bilateral acute angle closure caused by supraciliary effusions associated with venlafaxine intake

Lens Subluxation in Iris Retraction Syndrome Without Retinal Detachment

One patient with uveitis presented iris retraction syndrome then developed to angle-closure glaucoma. Ultrasound biomicroscopy showed iris retraction with posterior synechiae and supraciliary effusion. The typical characteristic of iris retraction syndrome—retinal detachment—did not present in this case. Uveitis and supraciliary effusion could be the possible cause of posterior chamber hypotony. The lens subluxation found during the cataract operation alerted us that lens subluxation could be occult in this situation.

Síndrome de Sturge-Weber: estudo ultrabiomicroscópico

OBJETIVO: Descrever os achados da biomicroscopia ultra-sônica (UBM) em pacientes com síndrome de Sturge-Weber associada ou não a glaucoma. MÉTODOS: Onze olhos (dois sem glaucoma e nove com glaucoma) de oito pacientes portadores de síndrome de Sturge-Weber foram submetidos à biomicroscopia ultra-sônica objetivando-se estudar o seio camerular, a esclera, o corpo ciliar e a pars plana. RESULTADOS: Identificou-se pela biomicroscopia ultra-sônica imagens compatíveis com a suspeita de vaso intra-escleral dilatado em todos os olhos com ou sem glaucoma. Efusão supraciliar foi encontrada em oito (88,9%) dos nove olhos com glaucoma, porém, em nenhum dos olhos sem glaucoma. Descolamento da pars plana foi diagnosticado em um olho com glaucoma e nos dois olhos sem glaucoma. Em oito (88,9%) olhos com glaucoma e nos dois sem glaucoma, observou-se imagem arredondada apresentando baixa a média ecogenicidade no interior do corpo ciliar, sugestiva de vaso dilatado (possível angioma) do corpo ciliar. CONCLUSÃO: Na síndrome de Sturge-Weber, a biomicroscopia ultra-sônica mostrou a presença de imagens sugestivas de vasos dilatados no interior da esclera e do corpo ciliar (possíveis angiomas) em olhos glaucomatosos e não glaucomatosos. Paradoxalmente, diagnosticou-se efusão supraciliar em oito (88,9%) dos nove olhos com glaucoma. Estes achados combinados com o angioma coroidiano e o aumento da pressão venosa episcleral em percentual elevado de olhos com esta síndrome, podem contribuir para explicar a patogenia do glaucoma, bem como as complicações per e pós-operatórias que acompanham as cirurgias antiglaucomatosas nesses olhos.

Ultrasound biomicroscopy in sturge-weber-associated glaucoma

To evaluate Sturge-Weber-associated glaucoma using ultrasound biomicroscopy. Case report. Clinical examination combined with ultrasound biomicroscopy was performed in a patient with Sturge-Weber-associated glaucoma. In the patient's left eye, which had Sturge-Weber-associated glaucoma, a 360-degree supraciliary effusion, dilated superficial and intrascleral vessels, and an open angle were detected by ultrasound biomicroscopy. The presence of dilated intrascleral vessels and supraciliary fluid support the hypothesis of increased episcleral venous pressure as the cause of elevated intraocular pressure in this syndrome.