Uveal Effusion Syndrome
In uveal effusion syndrome, abnormal scleral composition or thickness reduces transscleral aqueous outflow, inhibiting net fluid movement through the posterior eye wall. Choroidal and ciliary body thickening, RPE alterations, and exudative retinal detachment may occur. The choroid is often so thick that OCT imaging is not possible, but the gross thickening can be imaged with ultrasonography. Fluorescein angiography usually shows a leopard-spot pattern of hypofluorescence without focal leakage (Fig 9-17). Visual function may fluctuate. Although scleral window surgery may yield anatomical restitution, the visual results may be less satisfactory because of chronic, irreversible changes caused by the condition. A high index of suspicion for uveal effusion syndrome should be maintained for young patients with hyperopia whose disorder has been diagnosed as either CSC or retinal detachment without a retinal hole or tear. In some patients, intravitreal triamcinolone may cause resolution of fluid.
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Figure 9-17 Idiopathic uveal effusion. A–C, In this patient’s left eye, the visual acuity was reduced to 20/70, and systemic workup was negative. A, Fundus photograph demonstrates blunted foveal reflex and irregular, subtle subretinal deposits. B, Corresponding fluorescein angiography image reveals a diffuse leopard-spot pattern of blocking with intervening window defects involving the entire posterior pole. C, OCT scan reveals a small amount of subfoveal fluid and outer retinal deposits. Not shown is a peripheral serous retinal detachment. D, Fundus photograph from a separate case of recent-onset uveal effusion shows the typical appearance of serous retinal detachment syndrome as well as an underlying choroidal detachment, which is common for this condition.
(Parts A–C courtesy of Ronald C. Gentile, MD; part D courtesy of Colin A. McCannel, MD.)
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.