Anterior Lamellar Sclerectomy and Scleral Window Surgery in Nanophthalmic Eyes with Uveal Effusion Syndrome

We report the anatomical and visual outcomes of combined four-quadrant anterior lamellar sclerectomy and Kelly punch sclerostomy in 12 eyes of 12 patients with nanophthalmic uveal effusion syndrome, treated at a single referral center. Each eye underwent excision of approximately 90% of scleral thickness followed by full-thickness Kelly punch scleral window creation in every quadrant. Complete anatomical resolution was achieved in 11 of 12 eyes (91.7%) after a single procedure; the remaining eye resolved after four-quadrant revision. Mean time to resolution was 55.0 ± 39.2 days. Mean best-corrected visual acuity improved from 2.20 ± 0.29 logMAR (counting fingers) to 1.15 ± 1.11 logMAR (~20/280) at a mean follow-up of 43.2 months (p = .008); vision improved in 8 eyes (66.7%) and was stable in 4 (33.3%). Final visual acuity correlated with preoperative acuity (rho = 0.63, p = .028) but not with symptom duration, indicating that visual prognosis is governed by the severity of impairment at presentation. Intraocular pressure was unchanged, and no intraoperative vascular complications occurred. This technique provides durable anatomical resolution with an acceptable long-term safety profile, supporting timely surgical decompression before irreversible retinal pigment epithelial damage.