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Clinical science
Extensive circumferential partial-thickness sclerectomy in eyes with extreme nanophthalmos and spontaneous uveal effusion
  1. Ahmad Mansour, Opthalmology, Rafic Hariri University Hospital, Beirut, Lebanon1,2,
  2. Michael W Stewart3,
  3. Carol L Shields4,
  4. Rola Hamam5,
  5. Maamoun Abdul Fattah6,
  6. Huda Sheheitli7,
  7. Carl-Joe Mehanna8,
  8. Salma Yassine1,
  9. Hasan Chahine9,
  10. Mona Keaik6,
  11. Fadi Maalouf7,
  12. Mahmoud Jaroudi10,11
  1. 1 Ophthalmology, American University of Beirut, Beirut, Lebanon
  2. 2 Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon
  3. 3 Ophthalmology, Mayo Clinic Jacksonville, Jacksonville, Florida, USA
  4. 4 Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
  5. 5 Ophthalmology, American University of Beirut, Beirut, Lebanon
  6. 6 Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
  7. 7 Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
  8. 8 Ophthalmology, American University of Beirut, Hamra, Lebanon
  9. 9 Beirut, Lebanon
  10. 10 Ophthalmology, American University of Beirut, Beirut, Lebanon
  11. 11 Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon
  1. Correspondence to Dr Ahmad Mansour, Ophthalmology, American University of Beirut, Lebanon, Beirut 1136044, Lebanon; ammansourmd{at}gmail.com

Abstract

Aim To describe an extensive scleral excision technique to treat uveal effusion in nanophthalmic eyes.

Methods This prospective, interventional series of eight eyes of five consecutive patients with nanophthalmos underwent scleral window surgeries. Ninety per cent of the scleral thickness, extending from immediately behind the extraocular muscle insertions to the vortex veins for 3 and 1/4 quadrants, was removed. The main outcome measure was resolution of the uveal effusions.

Results Eight eyes of five patients (one female and four male) with a mean age of 46 years were studied. The mean (range) axial length was 16.1 mm (14.6–17.6 mm), and the mean refractive error was +13.6 dioptres (+10.75 to +16.00 dioptres). Following scleral excision surgery, all uveal effusions resolved within an average (±SD) of 13.9 (±8.7) days. The uveal effusion recurred in only one eye that had a vasoproliferative retinal tumour. The mean best corrected visual acuity improved from 0.69 logarithm of the minimum angle of resolution (logMAR) (Snellen equivalent: 20/97) at baseline to 0.51 logMAR (Snellen equivalent: 20/64; Wilcoxon paired t-test: p=0.016) after a mean follow-up of 35.6 months.

Conclusion The circumferential scleral window technique produces rapid resolution of uveal effusion in nanophthalmic eyes. No adverse effects were noted after surgery and the clinical effect was durable through 1 year.

Trial registration number NCT03748732.

  • sclera and episclera
  • retina
  • macula
  • uveal effusion
  • nanophthalmos

https://doi.org/10.1136/bjophthalmol-2018-313702

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    Footnotes

    • Contributors Design of the study: AM, MWS. Conduct of the study: AM, RH, MAF, HS, C-JM, SY, HC, MK, FM, MJ. Collection of data: AM, RH, MAF, HS, C-JM, SY, HC, MK, FM, MJ. Management of data: AM, RH, MAF, HS, C-JM, SY, HC, MK, FM, MJ. Analysis of data: AM, MWS, CLS, C-JM. Interpretation of data: AM, MWS, CLS, MAF, C-JM. Preparation of the manuscript: AM, MWS, CLS. Review of the manuscript: AM, MWS, CLS. Approval of the manuscript: AM, MWS, CLS, RH, MAF, HS, C-JM, SY, HC, MK, FM, MJ.

    • Competing interests MWS: consultant: Alkahest and Bayer; institutional research support: Allergan and Regeneron.

    • Patient consent for publication Not required.

    • Ethics approval Approval for this prospective, non-comparative, interventional study was granted by the Institutional Review Board of Rafik Hariri University Hospital. The study protocol followed the tenets of the Declaration of Helsinki. Written informed consent was obtained from each patient before entering the study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement AM has full data on all patients treated with this kind of surgery on nanophthalmos eyes.

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