Sclerectomies in nanophthalmos and idiopathic uveal effusion syndrome: a systematic review

Abstract

Purpose: Different scleral decompression surgical procedures have been proposed for the treatment of idiopathic and nanophthalmic uveal effusion syndrome (UES). The aim of this review is to describe the different surgical approaches reported in the literature and compare the outcomes and complications between them. Methods: We searched PubMed/MEDLINE, Scopus and Web of Science for all articles that reported scleral decompressive surgical procedures for idiopathic and/or nanophthalmic UES treatment, as well as publications reporting prophylactic surgeries for uveal effusion in nanophthalmic eyes. Risk of bias was assessed using the Cochrane proposed tool for randomized controlled trials - RoB2 and the JBI checklist for case series and for cohort studies. Results: Twenty-eight articles were included and reviewed. Sclerectomies were the most frequently reported procedures, associated or not with sclerostomies or sclerotomies. Following in frequency were sclerostomies and sclerotomies alone, whereas vortex vein decompression (VVD) was the less frequently reported surgery. Overall, the articles demonstrated positive results in the resolution of uveal effusion and retinal/choroidal detachment, as well as in the prevention of uveal effusion in nanophthalmic eyes. Improvement in visual acuity (VA) was reported by most authors, except in cases with long-term retinal detachments (RD), where retinal damage prevented an enhancement of VA even with good anatomical results. Moreover, three studies included the use of adjunctive treatment to the surgeries, particularly mitomycin C (MMC) and intravitreal anti-VEGF injections. Complications of scleral decompression surgeries were reported in only ten articles and the most frequent and serious ones included phthisis bulbi, retinal and suprachoroidal hemorrhage, and vortex vein incision, among others. Conclusion: In general, scleral decompressive surgeries showed efficacy in treating and preventing UES. However, bigger studies would be necessary to minimize possible bias and to draw more solid conclusions regarding the benefit of surgical management of these patients, compared to a conservative one, and to better understand if adjunctive treatment can be, in fact, beneficial or not.