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:
Sent: 03-03-2026 16:51
From: Joseph Rizzo
Subject: Optic disc edema in small eye after cataract surgery
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
Original Message:
Sent: 3/3/2026 3:35:00 AM
From: Michael Paul
Subject: RE: Optic disc edema in small eye after cataract surgery
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 |
Original Message:
Sent: 3/2/2026 6:13:00 AM
From: Michel Van Lint
Subject: Optic disc edema in small eye after cataract surgery
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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