Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
Sivas Cumhuriyet University Faculty of Medicine, Department of Ophthalmology, Sivas, Turkey
Turk J Ophthalmol. 2022 Feb 23;52(1):37-44. doi: 10.4274/tjo.galenos.2021.33723.
To report visual and anatomical outcomes following two- or four-quadrant partial-thickness sclerectomy and sclerotomy surgery to treat nanophthalmos (NO)-related uveal effusion (UE).
Consecutive patients with NO-related UE were treated with four-quadrant or two-quadrant (for those with associated glaucoma) partial-thickness sclerectomy and sclerotomy surgery. Axial length, extent of UE, preoperative, postoperative, and final best corrected visual acuity (BCVA), time to retinal reattachment, and rates of retinal reattachment and recurrence were noted.
Fourteen eyes of 10 patients with NO-related UE were operated. Retinal detachment (RD) involved mainly the peripheral retina in 7 (50%) eyes, macula in 2 eyes (14.2%), both macula and peripheral retina in 4 eyes (28.6%), and the whole retina in 1 eye. Eleven eyes had four-quadrant surgery, and 3 eyes with associated glaucoma had two-quadrant surgery. External subretinal drainage was performed in one patient who had total RD. The mean preoperative logMAR BCVA of 1.50±0.53 increased significantly to 0.92±0.49 after surgery (p=0.002). Resolution of RD could be achieved with two-quadrant surgery in only 1 of 3 eyes. In the other 2 eyes, retinal reattachment was achieved after a secondary surgery for the remaining two quadrants to complete four-quadrant sclerectomy. Final outcome was total reattachment of the retina in 11 eyes (78.6%), partial reattachment in 1 eye (7.1%), and recurrence of macular detachment in 2 (14.3%) eyes.
Quadrantic partial-thickness sclerectomy and sclerotomy surgery seems effective for treating UE in eyes with NO. Twoquadrant surgery may be tried for mild UE associated with glaucoma to preserve the superior quadrants for future possible glaucoma surgeries, but secondary surgery for the superior quadrants may be needed. External drainage of subretinal fluid may be an option in severe cases to achieve quicker resolution.
报告行四象限或两象限（合并青光眼者）部分厚度巩膜切除术和巩膜造口术治疗先天性小眼球（NO）相关葡萄膜渗漏（UE）的视力和解剖学结果。
对患有 NO 相关 UE 的连续患者行四象限或两象限（合并青光眼者）部分厚度巩膜切除术和巩膜造口术。记录眼轴长度、UE 程度、术前、术后和最终最佳矫正视力（BCVA）、视网膜复位时间以及视网膜复位和复发率。
10 例先天性小眼球相关 UE 患者的 14 只眼接受了手术。7 只（50%）眼的视网膜脱离（RD）主要累及周边视网膜，2 只（14.2%）眼累及黄斑，4 只（28.6%）眼累及黄斑和周边视网膜，1 只眼累及整个视网膜。11 只眼行四象限手术，3 只合并青光眼的眼行两象限手术。1 例完全性 RD 患者行眼外视网膜下液引流。术前平均 logMAR BCVA 为 1.50±0.53，术后显著提高至 0.92±0.49（p=0.002）。仅 1 只眼通过两象限手术即可实现 RD 复位。在另外 2 只眼中，通过对剩余两象限行二次手术完成四象限巩膜切除术，才实现视网膜复位。11 只眼（78.6%）视网膜完全复位，1 只眼（7.1%）部分复位，2 只眼（14.3%）黄斑脱离复发。
象限性部分厚度巩膜切除术和巩膜造口术似乎对先天性小眼球相关 UE 有效。对于合并青光眼的轻度 UE，可尝试行两象限手术以保留上方象限以备将来可能的青光眼手术，但可能需要对上方象限行二次手术。对于严重病例，眼外视网膜下液引流可能是一种更快实现复位的选择。
