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  • 1.  Optic disc edema in small eye after cataract surgery

    Posted 03-02-2026 06:13

    A 63-year-old lady was referred because of optic disc edema that was first noticed a week after cataract surgery.

    She had no complaints and the visual field was normal, but the eye fundus revealed a grade 3 optic disc edema with some peripapillary congested venes, as well as Paton lines temporal to the optic disc.

    The axial length is 19.71 mm.

    No RAPD.

    Imaging and lab tests are negative.

    She is now improving spontaneously.
    Do you think this may have been an uveal effusion type of response to the surgery?

    Sorry if this is a dumb question.

    Michel



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  • 2.  RE: Optic disc edema in small eye after cataract surgery

    Posted 03-02-2026 06:54

    A fluorescein angiogram would be helpful to look for irvine-gass syndrome which can sometimes present as disc edema being the most prominent feature rather than CME.

    OCT of the macula could be helpful to look for uveal effusion.

    If IOP was high before surgery and low after you can also get decompression disc edema.

    Best,

    Drew



    ------------------------------
    Andrew Carey
    Associate Professor
    Wilmer Eye Institute, Johns Hopkins Medicine
    Baltimore MD
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  • 3.  RE: Optic disc edema in small eye after cataract surgery

    Posted 03-02-2026 07:29

    Dear Andrew, 

    The OCT scan did not reveal macular edema. Ganglion cell layer is symmetric and appears to be normal. She never had a fluorescein angiography. I only saw her some time after the surgery when she already had started to improve. Ganglion cell layer is symmetric and appears to be normal. I am not too worried, but was just curious about what may have happened.

    Thank you!

    Michel

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    Original Message


  • 4.  RE: Optic disc edema in small eye after cataract surgery

    Posted 03-02-2026 12:08
    Michel,
     No it's not a dumb question. That's a very small axial length, basically nanophthalmos level. So I think it's totally possible that, esp if iop is low, she has a possible choridal congestion/uveal effusion type edema in that eye. Agree with FA and MAC OCT, maybe run the Oct by retina to look for choroid thickening and you can spot horizontal folds more easily if the Raster scans are vertical. I call these "raisin eyes" when they have hypotony or relative hypotony. It is self limited.
    That disc edema is a bit much for this without macular folds but would check it out.
    Kim 



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  • 5.  RE: Optic disc edema in small eye after cataract surgery

    Posted 03-02-2026 08:12
    A mild NAAION?

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  • 6.  RE: Optic disc edema in small eye after cataract surgery

    Posted 03-02-2026 09:14
    Sometimes it disc edema due to hypertension due to stress of surgery in susceptible patients but it should affect the other eye also or can be disc edema due to ocular hypotension after surgery from different causes so measure IOP with blood pressure and look to the other eye 
    Sherif 




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  • 7.  RE: Optic disc edema in small eye after cataract surgery

    Posted 03-03-2026 03:35
    Agree with previous suggestions on hypotony. What was the post op IOP? Any Seidel? Was the surgery uneventful, or was a vitrectomy done?
    Another possibility is postoperative uveitis that could cause swelling of the disc. 
    Uveal Effusion syndrome is a known complication in nanophthalmic eyes so this could be it.
    US can demonstrate thick sclera.


    --

    Michael Paul M.D

    Eye diseases and Surgery

    Director Emeritus

    Ophthalmic Plastic and Reconstructive Surgery

       ,Orbital and Lacrimal Surgery Service 

    Neuro-Ophthalmology

    Dept  of Ophthalmology

    Edith Wolfson Medical Center

    Holon, Israel

    972-3-5049554

    Fax: 972-3-5018703


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    		 03.03.26, 10:17:38





  • 8.  RE: Optic disc edema in small eye after cataract surgery

    Posted 03-03-2026 16:52

    Agree with the above.

     

    This syndrome was originally described by RJ  Brockhurst in 1974 (Trans Am Oph Soc) as a "new clinical entity". He described 5 cases.

     

    We had such a case in 2023 that presented with optic nerve swelling and visual field defect that looked like NAION. Her vision dropped from 20/70 to 20/300.  There were marked choroidal folds and venous congestion. After much discussion, a scleral window was made around a vortex vein; the vision improved fairly quickly to 20/60+2, although the (mostly) inferior field defect did not show obvious improvement.

     

    Other useful articles include:

     

    D. Sarraf, Ophthalmology, 2003 (3 patients). Bilateral choroidal folds and optic neuropathy: a variant of the crowded disk syndrome ?

     

    M. Uyama. Ophthalmology 2000. Three subgroups, one type ("type 1") with nanophthalmic eyes. Discussion of subscleral sclerectomy for this type of eye.

     

     

     

    Joseph Rizzo, MD

    Simmons Lessell Professor of Ophthalmology

    Director, Neuro-Ophthalmology Service

    Mass Eye and Ear / Harvard Medical School

     




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  • 9.  RE: Optic disc edema in small eye after cataract surgery

    Posted 03-05-2026 08:23

    Many thanks for everyone's responses. The IOP was measured to be 16 mmHg pre-op and 11 mmHg post-op, but these values may have been based on pneumotonometry.

    I have only seen the patient postoperatively, but next time, we will be sure to follow the advice as given above, including FA and ultrasound.

    NAION was  considered, but more than four weeks after surgery there is no thinning of the RNFL / GCL, there is no discernable RAPD and no visual field deficit. 

    Thank you and apologies for my late response

    Michel

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    Original Message


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