Response to: Idiopathic uveal effusion syndrome causing unilateral acute angle closure in a pseudophakic patient

Sir,

We read with interest the case report of presumed idiopathic uveal effusion syndrome (IUES) associated with unilateral acute angle closure (AAC) in a pseudophakic patient.¹

The authors propose that the case occurred in the absence of pupil block, however, the anterior segment OCT image presented shows iris convexity implying pupil block. We note that no posterior synechiae were seen clinically, however, the B-scan ultrasound images suggest adhesions between the posterior iris and the anterior capsule, consistent with seclusio pupillae. Pseudophakic pupil block with synechiae not visible at the pupillary margin can occur.² Furthermore, the case resolved with pupil dilation and medical intraocular pressure control supporting a pseudophakic pupil block mechanism.

The association of uveal effusion with AAC is well recognized and has been reported to occur in up to 58% cases of acute primary angle closure.³ As stated by the authors, IUES is a diagnosis of exclusion; and is typically associated with serous retinal detachment.⁴ No serous retinal detachment is seen in the case presented.

Their case is certainly unusual with respect to the fact that AAC occurred with an IOL placed in the capsular bag with presumed correct orientation. We would suggest the authors consider prophylactic peripheral laser iridotomy in their case to reduce the risk of a repeat AAC episode.

The authors declare no conflict of interest.