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Sir, We read with great interest the recent correspondence by Wang et al1 referring to our case series entitled ‘Medical therapy for uveal effusion syndrome'.2 Wang et al suggested in their case report that even in cases of UES with localised subretinal fluid, a surgical intervention with sclerotomies performed in all four quadrants may be necessary to successfully manage the patient. With UES being so rare in occurrence, evidence for treatment comes from case reports or case series. Until our case series, recommended therapy for the treatment of UES has been surgery. As reported in our paper, we managed to completely resolve the UES with medical therapy alone in two patients, whereas the third patient had to undergo surgery in the left eye. We decided to perform the surgery in a stepwise manner; with two inferior sclerotomies initially, leaving the option of further two sclerotomies for subsequent procedure, should the first one fail to resolve the effusion. After the surgical procedure, UES resolved completely, his VA increased from 20/50 to 20/20 and no recurrence was observed until the present day. The differences between our case and the one reported by Wang et al should also take into account the different findings in the histology of the sclera. In our case, even though the sclera was thickened, the histology did not show any abnormalities in connective tissue and there was no excessive accumulation of mucin. According to a study by Uyama et al,3 final results of the surgery depend on the subtypes of UES (nanophthalmic eye vs eye with normal axial length; abnormal sclera vs normal sclera on histology). From the reported case of Wang et al, it is not obvious whether medical therapy was introduced before the surgery or not; however, we believe that initial medical therapy may be a good approach to UES patients proceeding to surgery in refractory cases using a stepwise surgical approach. During initial surgery, two sclerotomies may be sufficient as was the case in our patient, but in other patients (different UES subtypes) four sclerotomies may be necessary, as suggested by Wang et al to achieve resolution of the disease.

Purpose To report a case series of three patients with bilateral uveal effusion syndrome (UES), treated conservatively with oral carbonic anhydrase inhibitors and topical prostaglandin analogues (PAs). Methods Three patients with bilateral UES were treated with the same initial therapy. Topical PA latanoprost 0.005% and acetazolamide 250mg were administered in order to reduce intraocular pressure, improve uveoscleral outflow, and facilitate resolution of uveal effusion. Results The chorioretinal detachment resolved within 3 months in two reported patients while the third one underwent surgery on his left eye. After clinical improvement, further oral therapy with acetazolamide was stopped, while topical prostaglandins were continued for at least the next 3 months. All patients were free from recurrence during the follow-up period. Conclusion Although the usually recommended UES therapy is partial or full-thickness sclerectomy, our case series showed apparent resolution of chorioretinal detachment in two patients on medical therapy alone. Conservative therapy may be the first step before the standard recommended surgical approach, but further studies are needed to verify the effectiveness of reported therapy.

Cilj ove studije bio je procijentiti kratkotrajni učinak intravitrealne primjene bevacizumaba u skupini bolesnika s neovaskularnim glaukomom. U studiju je bilo uključeno jedanaestero bolesnika s neovaskularnim glaukomom i simptomatskim povišenjem očnog tlaka. Kod svih bolesnika primijenjen je bevacizumab u dozi od 1, 25/0, 1 mL intravitrealno. Kod troje bolesnika je bevacizumab primijenjen jedan dan prije pars plana vitrektomije. Dodatna antiglaukomska terpaija primijenjena je samo kod onih bolesnika u kojih očni tlka nije bio dobro kontroliran lokalnom antiglaukomsom terapijom. Najkraće razdoblje praćenja bolesnika bilo je 8 tjedana. Intravitrealna primjena bevacizumaba dovela je kod svih bolenika do značajne regresije neovaskularizacije šarenice, što je trećega dana od primjene bevacizumaba potvrđeno biomikroskopski te fluoresceinskom angiografijom. U sedmoro bolesnika je očni tlak bio dobro kontroliran samo lokalnom antiglaukomskom terapijom. Kod četvero bolesnika bilo je potrebno daljnje kirurško antiglaukomsko liječenje. Nisu zabilježene nuspojave kao niti komplikacije za vrijeme ili poslije intravitrealne injekcije bevacizumaba. Zaključuje se kako se intravitrealna primjena bevacizumabačini dobrom dodatnom metodom u kombinaciji s ostalim terapijskim modalitetima liječenja neovaskularnog glaukoma. Dodatne studije kojima se ispituje dugotrajniji učinak i sigurnost intravitrealne primjene bevacizumaba su u tijeku i one će doprinijeti boljem razumijevanju farmakokinetike, toksičnosti i putova primjene bevacizumaba u liječenju neovaskularnog glaukoma.

Purpose: It has been hypothesized that isolated human communities are particularly favourable for identifying genetic variants underlying complex human traits and diseases because of their reduced genetic and environmental diversity. The aim of this study was to identify genomic loci that may control variation in visual quantitative traits in 1,057 examinees in isolated island of Vis, Croatia, by positional cloning. Methods: Using refractometer, ultrasound and Canon CR-DGI non-mydriatic fundus retinal camera we obtained a number of visual quantitative and qualitative traits in our set of examinees. All measurements have been adjusted for potential confounders that were identifyied through an appropriate questionnaire. Both linkage analysis and and genome-wide association approach were used (PLINK and GENABEL softwares) to identify genomic loci that may have significant contribution to the variation observed in those traits. Results: A number of loci have been identified in the genome that approached formal significance levels after Bonaferroni correction of 10-6. Those loci now require repeat in other populations to eliminate false positive findings, and further study in bioinformatics and functional genomics to understand their potential role in trait variation and possible development of pathological states. Conclusions: This study showes that mapping genetic variants underlying complex human traits in isolated population is a feasible and powerful approach. We aim to expand our studies to other Croatian islands to further increase the power of the study.