Medical management of post-phacoemulsification uveal effusion in nanophthalmos: A case report

TL;DR

This case report describes successful non-surgical treatment of a rare eye condition following cataract surgery in a patient with nanophthalmos.

Contribution

Demonstrates that medical treatment can effectively manage uveal effusion syndrome with exudative retinal detachment in nanophthalmos.

Findings

Non-surgical treatment with dexamethasone and acetazolamide resolved subretinal fluid and retinal detachment.

The patient achieved improved vision and anatomical stability over six months.

Conservative therapy may be a viable alternative to surgery in select nanophthalmic cases.

Abstract

Nanophthalmos presents a unique surgical challenge due to anatomical constraints and increased risk for postoperative complications. In presenting this case, our aim is to raise awareness of nanophthalmic uveal effusion syndrome (UES) and exudative retinal detachment (RD), emphasize the importance of accurate postoperative diagnosis in such cases, and challenge the prevailing notion that surgical intervention is required in such scenarios.

We report a case of successful non-surgical management of UES with exudative RD following uncomplicated cataract surgery in a nanophthalmic eye. A 65-year-old monocular female with nanophthalmos (axial length 15.25mm) underwent phacoemulsification with intraocular lens implantation. Postoperatively, the patient developed cystoid macular edema, and subretinal fluid. Prominent choroidal folds and the absence of retinal breaks aided the diagnosis of UES with exudative RD. Given the complexity of this case, and the patient's monocular status, we opted for a conservative approach. A regimen of topical dexamethasone and oral acetazolamide was initiated. Clinical improvement was observed within days, with complete resolution of subretinal fluid and reattachment of the retina over the following month. Six months postoperatively, best-corrected visual acuity improved to 6/12, with maintained anatomical and functional stability at one year.

This case highlights the importance of accurate postoperative assessment in nanophthalmic patients, particularly distinguishing exudative from rhegmatogenous RD. Furthermore, it underscores the potential for conservative therapy in managing UES, challenging the prevailing reliance on surgical intervention. Further research is needed to delineate criteria for medical management candidacy and optimize treatment regimens.

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