Choroidal Vessel Thickness Changes on Indocyanine Green Angiography After Scleral Windows for Uveal Effusion Syndrome

Purpose: To evaluate the impact of scleral windows on choroidal decompression in uveal effusion syndrome using indocyanine green angiography (ICGA). Methods: A retrospective case series of patients undergoing scleral windows surgery for uveal effusion syndrome was performed. ICGA imaging was analyzed preoperatively and postoperatively to assess choroidal vascular anatomy changes, with vessel diameter measurements standardized using custom Python image alignment software. Results: The patient cohort included 5 eyes from 4 patients with an average age of 56 years. There was an average vortex vein thickness reduction of 18% and an average macular vessel thickness reduction of 25%. All patients exhibited significant qualitative and quantitative postsurgical reductions in vortex vein and macular vessel diameters as viewed on ICGA. The inferonasal quadrant demonstrated the most pronounced vascular decompression. ICGA also revealed improved choroidal perfusion, supporting the efficacy of scleral surgery in alleviating congestion. Conclusions: Scleral windows surgery effectively reduces choroidal vascular congestion in uveal effusion syndrome. This study provides a novel imaging-based assessment method to quantify postsurgical choroidal changes after scleral windows surgery and further supports choroidal congestion as part of the underlying pathophysiology of uveal effusion syndrome and, potentially, pachychoroid spectrum disorders.