IOVS Journal of Nutrition
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Originally published In Press as doi:10.1167/iovs.08-1980 on June 14, 2008
 (Investigative Ophthalmology and Visual Science. 2008;49:5033-5040.)
© 2008 by The Association for Research in Vision and Ophthalmology, Inc.
DOI:  10.1167/iovs.08-1980
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Scleral Hydraulic Conductivity and Macromolecular Diffusion in Patients with Uveal Effusion Syndrome

Timothy L. Jackson,1,2 Ali Hussain,2 Ana M. S. Morley,2,3 Paul M. Sullivan,3 Andrea Hodgetts,2 Austen El-Osta,2 Jost Hillenkamp,2,4 Stephen J. Charles,5 Richard Sheard,6 Tom H. Williamson,2 Anupma Kumar,2 D. Alistair H. Laidlaw,2 W. Hong Woon,7 Mark J. Costen,8 Andrew J. Luff,8 and John Marshall2

1From the Department of Ophthalmology, King’s College Hospital, London, United Kingdom; 2King’s College London, The Rayne Institute, St. Thomas’ Hospital, London, United Kingdom; the 3Vitreoretinal Unit, Moorfields Eye Hospital, London, United Kingdom; the 4Department of Ophthalmology, University Hospital Schleswig-Holstein, Kiel, Germany; the 5Royal Eye Hospital, Manchester, United Kingdom; the 6Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom; the 7Leeds General Infirmary, Leeds, United Kingdom; and the 8Southampton General Hospital, Southampton, United Kingdom.

PURPOSE. To determine whether uveal effusion syndrome (UES) is caused by altered scleral permeability to water and large molecules.

METHODS. Transscleral water movement was measured using surgically removed sclera clamped in a modified Üssing chamber and connected to a water column set at intraocular pressure. Sclera was also clamped between two hemichambers, and transscleral diffusion of FITC-dextrans (4.4–77 kDa) was measured with a spectrophotometer. Clinical data were prospectively collected using postal questionnaires.

RESULTS. Ten patients (mean age, 63 years; mean spherical equivalent, +4.7 D) had a median preoperative visual acuity of 0.20 that improved to 0.33 after surgery. Nine eyes showed visual improvement, three worsened, and two were unchanged. Histology showed disorganization of collagen fibrils, with amorphous deposits expanding the interfibrillary spaces. The mean thickness (±1 SD) of the excised scleral specimens was 585 ± 309 µm, and the mean specific hydraulic conductivity was 23.9 ± 27.5 x 10–14 cm2, compared with 5.8 ± 3.9 x 10–14 cm2 in age-matched control specimens (P = 0.068). Three specimens had hydraulic conductivity above the 95% CI of the controls. Control eyes showed a significant reduction in diffusion coefficient (D) with age. Eyes had a mean D of 5.69 ± 5.35 x 10–8 cm2 · s–1, similar to control eyes (6.14 ± 2.40 x 10–8 cm2 · s–1, 20 kDa dextran). In one eye, the result was higher than the 95% CI of the control; in three, it was lower.

CONCLUSIONS. UES is not caused by reduced scleral hydraulic conductivity, which tends to be higher than expected. Reduced macromolecular diffusion may impede the normal transscleral egress of albumin with subsequent osmotic fluid retention in some, but not all eyes.






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