Sir,

We read with great interest the recent correspondence by Wang et al1 referring to our case series entitled ‘Medical therapy for uveal effusion syndrome’.2

Wang et al suggested in their case report that even in cases of UES with localised subretinal fluid, a surgical intervention with sclerotomies performed in all four quadrants may be necessary to successfully manage the patient.

With UES being so rare in occurrence, evidence for treatment comes from case reports or case series. Until our case series, recommended therapy for the treatment of UES has been surgery.

As reported in our paper, we managed to completely resolve the UES with medical therapy alone in two patients, whereas the third patient had to undergo surgery in the left eye. We decided to perform the surgery in a stepwise manner; with two inferior sclerotomies initially, leaving the option of further two sclerotomies for subsequent procedure, should the first one fail to resolve the effusion. After the surgical procedure, UES resolved completely, his VA increased from 20/50 to 20/20 and no recurrence was observed until the present day.

The differences between our case and the one reported by Wang et al should also take into account the different findings in the histology of the sclera. In our case, even though the sclera was thickened, the histology did not show any abnormalities in connective tissue and there was no excessive accumulation of mucin. According to a study by Uyama et al,3 final results of the surgery depend on the subtypes of UES (nanophthalmic eye vs eye with normal axial length; abnormal sclera vs normal sclera on histology).

From the reported case of Wang et al, it is not obvious whether medical therapy was introduced before the surgery or not; however, we believe that initial medical therapy may be a good approach to UES patients proceeding to surgery in refractory cases using a stepwise surgical approach.

During initial surgery, two sclerotomies may be sufficient as was the case in our patient, but in other patients (different UES subtypes) four sclerotomies may be necessary, as suggested by Wang et al to achieve resolution of the disease.