Uveal Effusion Research Articles

Glaucoma agudo bilateral secundário al uso de topiramato como tratamiento para la perdida de peso

Topiramate is a drug used in the treatment of epilepsy, migraine, bulimia and other pathologies. We report a case of a 40-years-old woman, presented to the emergency department of ophthalmology with blurred vision in both eyes and bilateral acute angle closure. Her medications included topiramate started 6 days before Secondary angle closure glaucoma due to topiramate was diagnosed. The medication was discontinued and she was treated with topical antiglaucoma medications, intravenous mannitol and cyclopegics. At the 5-days follow-up visit, vision, intraocular pressure, and angle anatomy had returned to normal. The acute angle-closure glaucoma occurs due to edema of the ciliary body and uveal effusion that produces an anterior motion of the iris-lens diaphragm , with ocular hypertension and acute myopia .

Cataract surgery in patients with nanophthalmos: results and complications.

To evaluate phacoemulsification surgery results and complications in patients with nanophthalmos. The records of 9 patients with nanophthalmos who had cataract surgery from January 2011 through January 2015 were retrospectively reviewed. Nanophthalmos was diagnosed by the presence of an eye with an axial length (AL) less than 20.5 mm. The records were reviewed for ocular diagnosis, keratometry, anterior chamber depth (ACD), AL, ocular surgeries, visual acuity, and complications. A total of 14 eyes of 9 patients (8 women, 1 man) with a mean age of 72 years (range 48-86) were reviewed. Mean AL was 18.72 mm and mean ACD was 2.30 mm. Mean preoperative spherical equivalent (+8.55 ± 6.44 diopters (D)) was reduced to +0.30 ± 2.17 D at last follow-up visit. Mean best-corrected visual acuity (BCVA) was +0.68 ± 0.55 logarithm of the minimum angle of resolution (logMAR) preoperatively and improved to +0.55 ± 0.73 logMAR at last follow-up visit. Visual acuity remained stable or improved in 11 eyes. Five eyes did not achieve final BCVA ≥+0.3 logMAR. Complications occurred in 3 eyes (21.4%) and included 1 case of posterior capsule rupture, 1 case of severe iritis and rhegmatogenous retinal detachment 2 weeks postoperatively, and 1 other case of iritis. No postoperative uveal effusion was seen. Although phacoemulsification seems to be relatively safe in nanophthalmic eyes, surgeons need to be aware of the challenges of this procedure in these high-risk eyes. Nevertheless, with careful preoperative evaluation and planning, most cases were uncomplicated and resulted in improvement of BCVA.

Efusión uveal inducido por escitalopram

Case reporTA 73 year-old woman with depression treated with escitalopram developed acute secondary angle closure glaucoma related to uveal effusion after duplicating the drug dose 3 days before. She evolved favorably once the antidepressant treatment was suspended and a new treatment with topical hypotensive therapy and oral prednisone was used. DiscussionThe uveal effusion syndrome associated to medicines is rare; it may be associated with acute myopic shift and acute angle closure glaucoma. The correct diagnosis and discontinuation of the drug lead to the resolution of this nosology.

Uveal Effusion as a Mechanism of Bilateral Angle-Closure Glaucoma Induced by Chlorthalidone

To report a novel case of acute bilateral uveal effusions, angle closure, and acute myopia induced by administration of chlorthalidone. Case report. Bilateral shallow anterior chambers, high intraocular pressure, and a myopic shift were encountered in a patient 1 week after initiation of chlorthalidone. Ultrasound evaluation revealed bilateral ciliochoroidal effusions, appositional angle closure, and suspected ciliary body edema. Cessation of chlorthalidone, in addition to administration of cycloplegics and ocular antihypertensives, resulted in prompt resolution of this idiosyncratic reaction. The antihypertensive medication chlorthalidone may cause bilateral uveal effusions inducing acute angle-closure glaucoma and acute myopia.

Methyl-Sulfonyl-Methane (MSM)-Induced Acute Angle Closure

To report the first case of presumed bilateral acute angle closure (AAC) secondary to ingestion of the dietary supplement, methyl-sulfonyl-methane (MSM). A 35-year-old woman presented with bilateral AAC 1 week after starting multiple dietary supplements, one of which contained MSM. Ultrasound biomicroscopy demonstrated bilateral anterior rotation of the iris-lens diaphragm, ciliary body edema, and choroidal effusion. Four days after discontinuation of the supplements, her angle closure and uveal effusion resolved, and her best-corrected vision recovered to 20/20 bilaterally. Sulfa-based drugs have been reported to cause AAC, choroidal effusion, and ciliary body edema. In our patient, the coincidence of bilateral AAC with choroidal and ciliary body effusion that began 1 week after starting dietary supplements was suspicious for drug-induced AAC. The dietary supplement Basic Detox Nutrients contains MSM, the only constituent in the patient's medication list with a sulfonyl moiety. Given the similarities in chemical structure and clinical presentation, we postulate that MSM induces AAC in a manner similar to mechanisms previously described for other sulfa-based drugs. As MSM continues to be used and studied for its anti-inflammatory and antioxidative properties, investigators and marketers will need to be cognizant of its potential to cause AAC and provide proper warning to consumers.

English

Topiramate is an oral sulfamate medication used primarily for seizure treatment and has also demonstrated efficacy in the treatment of bipolar disorders and migraine. The mechanism of causation of angle closure and acute myopia is not clearly understood and several theories have been proposed of which the uveal effusion theory is widely accepted. We report a case of topiramate induced acute myopia with bilateral acute angle closure. With the increase in the frequency of prescribing topiramate for migraine prophylaxis it is important that the prescribing physicians should be aware of these complications. It is also important to educate the patients regarding the possible symptoms so that they can report at the earliest. INTRODUCTION: Several drugs are known to cause angle closure and induce acute myopic shift in refraction. The mechanism of causation is not clearly understood and several theories have been proposed. Topiramate is a new antiepileptic drug which is used in several medical conditions like migraine, epilepsy, de addiction. We report a case of topiramate induced acute myopia, with acute angle closure which was wrongly diagnosed. A 39 year old male presented with history of sudden onset headache with nausea and vomiting of 2 days duration. He was using spectacles of -1.00DS/-1DC x 90° in the right eye and1.25DS/-1.00DC x 90° in the left eye of for the past 20years. He was a known alcoholic was under the care of psychiatrist and had undergone de addiction 10 years ago. 10 days ago he had a relapse and presented with disulphiram like reaction after a binge of alcohol. He was admitted and then was discharged on tab topiramate 25mgfor 3 days followed by 50 mg for 10 days. 5 days after initiating treatment he presented with sudden onset headache with nausea and vomiting. On examination he was restless but oriented, his vitals were stable. He was clinically diagnosed to have a cerebro vascular accident and was admitted in the intensive care unit. A whole battery of investigations was ordered including CT brain which was all normal. Finally the ophthalmologist was called in owing to bilateral congestion and chemosis in the eyes (Fig-1). On examination he had 45degrees of exotropia, his visual acuity in both the eyes was 2/200 improving with pinhole to 20/20, near vision N6. Refraction was -8.00 DS/ 2.75DC x90°in the right eye and 8.00DS/-2.00DC x90° in the left eye. AC was shallow (Fig-2) and pupils were 4mm sluggishly reacting to light. IOP measured by applanation was 40 and 42 mmHg in the right and left eye respectively. Gonioscopy showed 360 degrees oppositional angle closure in both eyes (Fig-3). Examination of fundus showed the presence of fine retinal striae radiating from the fovea and no peripheral choroidal detachment. A diagnosis of topiramate induced acute bilateral angle closure with bilateral acute myopia was made and the drug was discontinued immediately in consultation with the psychiatrist. When reviewed 24 hours after the discontinuation of medication, his BCVA was 20/60 with previous acceptance. AC was still shallow and IOP measured by applanation was 37 mm of Hg in DOI: 10.14260/jemds/2014/3978

Uveal effusion associated with an IgM lambda subtype monoclonal gammopathy

Case reportA 68-year-old man was referred to the hospital with progressive decreased vision in the right eye over the past year. A moderate cataract and annular choroidal thickening were found. The diagnosis of uveal effusion was confirmed by ultrasound and fluorescein and indocyanine green angiography. Laboratory studies showed an IgM lambda subtype monoclonal gammopathy of undetermined significance. The patient underwent cataract surgery, and a sub-Tenon's triamcinolone injection with a satisfactory short-term outcome. ConclusionThis association has not been previously reported, and it shows that IgM lambda subtype monoclonal gammopathy of undetermined significance should be added to the list of disorders associated with uveal effusion.

Role for Rapid Surgical Intervention in Uveal Effusion Syndrome With Associated Optic Neuropathy

Uveal effusion syndrome (UES) can be associated with nanophthalmos and rarely can present with concomitant optic neuropathy. This case report describes nanophthalmic UES and optic neuropathy treated with early sclerectomies. One month postoperatively, the patient experienced significant improvement in choroidal effusions and optic neuropathy, with increases in visual acuity and visual fields. Early scleral windows surgery for UES with associated optic neuropathy can provide prompt improvement of choroidal swelling, optic nerve edema, and vision, although the relapsing course of this disease presents a challenge to long-term visual prognosis.

Efusión uveal asociada a gammapatía monoclonal de significado indeterminado tipo IgM lambda

Case reportA 68-year-old man was referred to the hospital with progressive decreased vision in the right eye over the past year. A moderate cataract and annular choroidal thickening were found. The diagnosis of uveal effusion was confirmed by ultrasound and fluorescein and indocyanine green angiography. Laboratory studies showed an IgM lambda subtype monoclonal gammopathy of undetermined significance. The patient underwent cataract surgery, and a sub-Tenon's triamcinolone injection with a satisfactory short-term outcome. ConclusionThis association has not been previously reported, and it shows that IgM lambda subtype monoclonal gammopathy of undetermined significance should be added to the list of disorders associated with uveal effusion.

Small eyes big problems: is cataract surgery the best option for the nanophthalmic eyes?

Nanophthalmos refers to an eyeball of short axial length, usually less than 20 mm which leads to angle closure glaucoma due to relatively large lens. Intra-ocular lens extraction relieves the angle closure in nanophthalmos. Cataract surgery in a nanophthalmic eye is technically difficult with high risk of complications such as posterior capsular rupture, uveal effusion, choroidal haemorrhage, vitreous haemorrhage, malignant glaucoma, retinal detachment and aqueous misdirection. Various options are explained in the literature to perform cataract surgery in nanophthalmos, like extracapsular cataract extraction with or without sclerostomy; small-incision cataract extraction by phacoemulsification which not only helps maintain the anterior chamber during surgery but also reduces the incidence of complications due to less fluctuation of intraocular pressure (IOP) during the surgery. Cataract surgery deepens and widens the anterior chamber angle in nanophthalmic eyes and has beneficial effects on IOP in eyes with nanophthalmos but is associated with a high incidence of complications.

A MODIFIED ULTRASOUND-GUIDED SURGICAL TECHNIQUE FOR THE MANAGEMENT OF THE UVEAL EFFUSION SYNDROME IN PATIENTS WITH NORMAL AXIAL LENGTH AND SCLERAL THICKNESS

The purpose of this study was to describe a modified surgical technique for the management of the uveal effusion syndrome (UES). A consecutive interventional case series of six eyes with UES is reported. The diagnosis of the UES was based on detailed ophthalmic examination, fluorescein angiography, B-scan ultrasonography, biometry, and magnetic resonance imaging. All eyes underwent an ultrasound-guided placement of the sclerostomies subjacent to the area of maximal choroidal swelling using a scleral punch without scleral flaps or vortex vein decompression. All patients were men with a mean age of 53 years. The mean postoperative follow-up was 16.25 months. Five eyes had normal axial lengths (22.54-23.05 mm) by ultrasound and normal sclera thickness on magnetic resonance imaging. One eye had a shorter axial length (21.65 mm) and mild scleral thickening on magnetic resonance imaging. All six eyes had anterior peripheral choroidal swelling. Three eyes had associated serous retinal detachment, and three eyes had acute appositional angles. After surgery, five eyes had total resolution of the peripheral choroidal swelling and retinal detachment or normalization of the angle. One eye had partial resolution of the retinal detachment. Of the three eyes with retinal detachment, two eyes experienced improvement in visual acuity after surgery. No complications were noted. This modified ultrasound-guided surgical technique for sclerostomy placement seems to be effective in the management of the UES, including eyes with normal axial length and scleral thickness, a subset of the UES that has been previously reported not to respond to surgery.

Resolution of Serous Retinal Detachment Following Partial Sclerectomy With Mitomycin C in Nanophthalmos

The authors report the results of partial-thickness sclerectomy combined with mitomycin C in a nanophthalmic eye with serous retinal detachment. Partial sclerectomy in two quadrants with adjuvant use of mitomycin C without drainage of subretinal fluid was performed. The patient was monitored with serial fundus photographs and spectral-domain optical coherence tomography (SD-OCT) for up to 16 weeks postoperatively. Best corrected visual acuity improved from counting fingers at 1 meter preoperatively to 6/60 at final follow-up. There was gradual but complete resolution of serous retinal detachment both clinically and on SD-OCT. Partial-thickness sclerectomy with mitomycin C is an effective and safe procedure in the management of nanophthalmic eyes with uveal effusion.

A Novel Technique for Choroidal Fluid Drainage in Uveal Effusion Syndrome

Uveal effusion syndrome (UES) is a rare disorder associated with thickening of the choroid and secondary retinal detachment as a possible serious complication. UES occurs in hypermetropic or nanophthalmic eyes or can be idiopathic and is a diagnosis of exclusion. Vortex vein decompression, sclerectomy or sclerotomy, and drainage of choroidal fluid are surgical treatment options. The authors describe a novel surgical technique for drainage of serous choroidal detachment using a penetrating diathermy probe in two patients with UES. The procedure involves drainage of choroidal fluid by using a penetrating diathermy probe (2 mm tip length) after placing a 20-gauge infusion line in the anterior chamber. Choroidal fluid drainage was successful in both patients, with satisfactory outcome on follow-up. The proposed simple and feasible surgical drainage technique may improve the management of patients with UES.

Topiramate-associated acute, bilateral, angle-closure glaucoma: case report

This paper describes a topiramate induced acute bilateral angle-closure glaucoma. This rare adverse effect is an idiosyncratic reaction characterized by uveal effusion and lens forward displacement, leading to increased intraocular pressure and vision loss. We describe a 55 year-old white woman with migraine, spasmodic torticollis and essential tremor, who developed bilateral acute angle-closure glaucoma, one week after starting topiramate 25 mg/day. She was seen at the Ophthalmology Emergency Department of the Fundação João Penido Burnier (Campinas, SP, Brazil) with a 4 hours history of blurry vision, ocular pain and bright flashes vision. Slit lamp examination revealed moderate conjunctival injection and corneal edema, and shallow anterior chambers. Intraocular pressure was 48 mmHg in both eyes. Fundoscopic examination findings were normal. She was treated with timolol, brimonidine, dorzolamide, pilocarpine, prednisone acetate eye drops and acetazolamide. One hour after those measures, as the intraocular pressure was 30 mmHg, she received a manitol intravenous injection and the intraocular pressure normalized. After 24 hours an iridotomy with Yag laser was performed. Topiramate was discontinued and she was totally recovered after one week.

Leopardenmuster in der Fluoreszenzangiographie

The uveal effusion syndrome is a rare disease characterized by serous choroidal detachment. The pathogenesis of idiopathic uveal effusion syndrome has not yet been conclusively established. One hypothesis is an abnormality of diffusion of extravascular proteins in the choroid leading to decompensation of the pigment epithelium pumping capacity. Fluid then accumulates in the subretinal space leading to retinal detachment which results in loss of visual acuity. It typically affects males and hypermetropia is another risk factor. When looking at the fundus a circular serous detachment of the choroid and choroidal puckering is typical. The fluorescein angiography shows hyperfluorescence in the form of a leopard-spot pattern. Space-occupying lesions have to be excluded with the help of ultrasound or magnetic resonance tomography. The uveal effusion syndrome is a diagnosis by exclusion. Treatment varies because of the different hypotheses for the pathogenesis. An intraocular tamponade in combination with laser coagulation may for example be an effective treatment.

Spectral-domain Optical Coherence Tomography Characteristics of Chorioretinal Folds

Purpose: To describe the spectral-domain optical coherence tomography features of chorioretinal folds of various etiology. Materials and methods: Cross-sectional observational case series of consecutive patients with chorioretinal folds. All patients underwent enhanced depth imaging optical coherence tomography over a two-month study period. Clinical variables and imaging features including subfoveal choroidal thickness and chorioretinal fold morphology were analysed. Results: 11 of 628 patients evaluated presented with chorioretinal folds. Diagnoses included hyperopia, uveal effusion, and secondary to surgery or medications. 22 patients presented with lesions simulating chorioretinal folds on ophthalmoscopy but were found not to be true chorioretinal folds with optical coherence tomography. Subfoveal choroidal thickness was diffusely thick in hyperopia, uveal effusion, hypotony, and topiramate, and normal in cases following scleral buckle and trauma. Lesions simulating chorioretinal folds occurred in age-related choroidal atrophy, and demonstrated chorioretinal contour changes involving specific choroidal vessels in an overall thin choroid. Conclusion: Chorioretinal folds occurred in the context of a diffusely thick choroid in high hyperopia and hypotony, and with a normal choroidal thickness following scleral buckle or trauma. Enhanced depth imaging OCT is helpful in differentiating chorioretinal folds from various etiologies and from simulating lesions.

Full-thickness Sclerotomy for Uveal Effusion Syndrome

To report the surgical outcome of full-thickness sclerotomy in five cases of uveal effusion syndrome (UES). Full-thickness sclerotomy without sclerectomy was performed on five eyes of four patients with UES with or without nanophthalmos. In four of the eyes, exudative retinal detachment associated with UES resolved after the sclerotomy. The subretinal fluid in one eye, which had a normal axial length, was relieved after undergoing three sclerotomy procedures. Full-thickness sclerotomy without vortex vein decompression or sclerectomy is an effective surgical option for the management of significant UES.

Bilateral nanophthalmic uveal effusion syndrome: clinical presentation and surgical management.

To describe the clinical presentation and surgical management of bilateral uveal effusion syndrome in a type 1 diabetic patient with nanophthalmos. A 38-year-old man presented with decreased visual acuity. Fundus examination revealed exudative retinal detachment and choroidal folding. Ultrasound examination confirmed thickened sclera, choroidal effusion, and nanophthalmos. Partial thickness scleral windows and subscleral sclerectomy were performed. The patient returned 2 years postoperatively with the same presentation in the contralateral eye. After subscleral sclerectomy, intraocular pressure remained stable and the patient recovered premorbid vision in both eyes. At 4 years of follow-up, the patient's vision had remained stable without the need for further treatment. The association of uveal effusion syndrome with diabetes and other autoimmune disorders is unclear, warranting further research. Uveal effusion syndrome can be managed effectively by partial thickness scleral windows and sclerectomy with improvement and maintenance of visual acuity.

Cataract Surgery in Patients with Nanophthalmos

To report the visual outcomes and complications of cataract surgery in a large series of patients with nanophthalmos. Retrospective, interventional case series. Forty-three eyes with an axial length ≤ 20.5 mm of 32 adult patients who underwent cataract surgery in a tertiary clinic. Medical records of patients undergoing cataract surgery between 1994 and 2010 were reviewed. Best-corrected visual acuity (BCVA) at 6 months after surgery and postoperative complications occurring during the entire follow-up period. Forty-three eyes of 32 patients (aged 19-87 years; median, 69 years) were included. Cataract surgery resulted in improvement of ≥ 3 Snellen lines in 19 eyes (44.2%). Two eyes (4.7%) lost ≥ 3 Snellen lines because of corneal decompensation in one and angle-closure glaucoma in the other. During the entire follow-up period, complications occurred in 12 eyes (27.9%). The most frequent complications were uveal effusion (9.3%) and cystoid macular edema (CME) (7.0%). Cataract surgery in patients with nanophthalmos remains a surgical challenge, and complications often occur in these high-risk eyes.

Enfermedad de Vogt-Koyanagi-Harada

The Vogt-Koyanagi-Harada (VKH) disease, formerly known as uveomeningitic syndrome, is a bilateral diffuse granulomatous panuveitis associated with exudative retinal detachment, which can be accompanied by central nervous system involvement, dermatological and auditory alterations.Its name derives from the authors who first described the disease. It affects adults of both genders, between 20 and 50 years old, with darkly pigmented races prevalence. This inflammatory syndrome is probably the result of an autoimmune mechanism, influenced by genetic factors.The evolution of the disease is divided into four clinical stages: prodromal, acute uveitic, convalescent and chronically recurrent. The diagnosis is mainly clinical, using the criteria established by the American Society of Uveitis (AUS) posted in the year 2001. Differential diagnosis must be done with sympathetic ophthalmopathy, primary B cell lymphoma, posterior scleritis, and uveal effusion syndrome. An early and maintained treatment is the basis of a favorable outcome.