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Bilateral sequential uveal effusion syndrome after one‐quarter of a century

The uveal effusion syndrome (UES) is characterized by serous detachment of the peripheral choroid, ciliary body and retina. It can rarely affect both eyes, usually after a delay of months to years. A 72-year-old man presented 2 months following routine left cataract surgery with painless loss of vision in the left eye. Visual acuity was 6/36 OS. Preoperative refraction was +6.50 OS and axial length 21.2 mm. Right visual acuity was unchanged at counting fingers secondary to spontaneous UES 25 years earlier. Anterior segment was unremarkable. Left fundoscopy revealed 360° choroidal detachment (Fig. 1). Despite treatment with prednisolone 60 mg OD, his vision 2 weeks later and fundus appearance was unchanged. Ultrasound B scan of the left eye showed annular choroidal detachment with serous retinal detachment inferiorly and inferonasally (Fig. 2). Orbital magnetic resonance imaging with contrast did not show scleral thickening, orbital fistulas or arteriovenous malformations (Fig. 3). He underwent two full-thickness sclerectomies (5 mm ¥ 4 mm). Vortex veins and sclera were grossly normal. Histopathologic examination of the excised sclera revealed only fibrosis and haemosiderin deposition. Four months later, left visual acuity had improved to 6/18 with pinhole, but was unchanged in the right eye. The serous detachment had reduced (Fig. 4) and steroids were finally stopped. The UES is an idiopathic condition typically affecting middle-aged men and presenting with serous retinal detachment with shifting subretinal fluid. Other signs include dilated episcleral veins, blood in Schlemm’s canal and a classic leopard spot pigmentation of the retinal pigment epithelium.