Double inferior scleral flaps with intraoperative mitomycin-C for uveal effusion syndrome: a case report.

Introduction and importance: Uveal effusion syndrome (UES) is a rare condition characterized by fluid accumulation in the suprachoroidal space and is often associated with scleral thickening and impaired transscleral outflow. The management of UES is challenging. We present a case of UES successfully managed with a modified surgical technique involving double scleral flaps with mitomycin-C. Case presentation: A 43-year-old man presented with sudden, painless, decreased vision in his left eye. Clinical examination and imaging revealed bilateral optic disc swelling, choroidal thickening, and inferior exudative retinal detachment in the affected eye. The axial lengths were short, suggestive of nanophthalmos. After an unsuccessful trial of high-dose oral corticosteroids, the patient underwent surgery involving two inferior scleral windows using double scleral flaps, central sclerotomy, and intraoperative application of mitomycin-C. Histopathology revealed a thickened sclera without inflammation. The effusion resolved completely within 6 months postoperatively, with no recurrence over a 2-year follow-up. Discussion: UES remains a surgical challenge, particularly in patients with eyes that have thick sclerae, where conventional drainage is ineffective. The aim of our approach was to reduce scleral resistance to fluid egress while preserving structural integrity. Long-term patency of the scleral windows was likely maintained by the use of mitomycin-C, which helped prevent fibrosis. Compared with previously described techniques, this modification is effective, safe, and structurally conservative. Conclusion: Double scleral flaps combined with mitomycin-C can be an effective surgical option for managing UES. The long-term resolution achieved in this case supports the value of this technique.