Chronic hypotony management using endoscopy-assisted vitrectomy after severe ocular trauma or vitrectomy

Abstract

Aim: To report outcomes of endoscopy-assisted vitrectomy (EAV) in patients with chronic hypotony following severe ocular trauma or vitrectomy.

Methods: This was a retrospective, noncomparative case series. Ciliary bodies were evaluated using ultrasound biomicroscopy pre-operatively and direct visualisation intraoperatively. All selected individuals (seven patients/seven eyes) underwent EAV. Removal of ciliary membrane and traction, gas/silicone oil tamponade (GT/SOT), and scleral buckling (SB) were performed in selected eyes. Outcome measurements mainly included intraocular pressure (IOP) and best-corrected visual acuity (BCVA).

Results: Seven eyes from 7 male aphakic patients with a mean age of 45 (range, 20-68)y were included in this study; the average follow-up time was 12 (9-15)mo. GT was performed in 2 eyes; membrane peeling (MP) and SOT in 2 eyes; and MP, SOT, and SB in 3 eyes. The mean pre- and post-operative IOP were 4.5 (range, 4.0±0.11 to 4.8±0.2) mm Hg and 9.9 (range, 5.6±0.17 to 12.1±0.2) mm Hg at 52wk (12mo), respectively. BCVA improved in six eyes; one eye still showed light perception, and no bulbi phthisis was observed.

Conclusion: Endoscopy offers improved judgment and recognition and has an improved prognosis for chronic hypotony. Therefore, endoscopy can be an effective and promising operative technique for chronic traumatic hypotony management.

Keywords: anterior proliferative vitreoretinopathy; anterior vitreous segment; chronic hypotony; endoscopy-assisted vitrectomy; trauma.

Figure 1. Anterior segment photographs of the patients

A: Patient 1 had severe blunt ocular trauma, with a transparent cornea and absence of the posterior capsule and aphakia. B: Patient 2 had ruptured globe injury, with an irregular corneal scar, leukoma, and aphakia; the other posterior segments could not be clearly observed. C: Patient 3 had severe alkali burns with keratoprosthesis, absence of the posterior capsule, and aphakia. D and E: Patients 4 and 5 had retinal detachment post-vitrectomy with a transparent cornea; however, the small pupil was caused by synechiae and posterior capsular opacification and aphakia. Silicone oil tamponade was applied in the vitreous body. A silicone oil bubble could be seen in the anterior chamber. F: Patient 6 had a severe ruptured globe injury, with a corneal scar in the inferotemporal region, absence of a posterior capsule, and aphakia. G: Patient 7 had a severe explosion injury and post-vitrectomy, with a corneal scar in the temporal region, absence of a posterior capsule, and aphakia.

Figure 2. Anterior segment shown using UBM

A: Normal structure of the anterior segment. The chamber angle, ciliary body, scleral spur, and sclera can be recognised. Red asterisks show the ciliary body. B-F: Anterior segments of Patients 1, 2, 4, 5, and 7, respectively; yellow asterisks reveal the ciliary body detachment, and white triangles indicate the cyclitic membrane on the ciliary body. UBM: Ultrasound biomicroscopy.

Figure 3. The view of the anterior vitreous segment shown using endoscopy

A: Normal structure of the ciliary body, velvet-like vitreous body, and ora serrata. B: AVS of Patient 4, the vitreous body, ora serrata, and normal and atrophied ciliary body could be seen, and a membrane covered the ciliary body. C: AVS of Patient 7, the vitreous cutting and ora serrata could be seen. While the ciliary body was difficult to find, a cotton-like membrane gathered on the surface of the ciliary body and led to traction. AVS: Anterior vitreous segment.

Figure 4. Pre- and post-operative average intraocular pressure (IOP) in individual patients

Six patients showed an increase in IOP, and only one eye of one patient maintained hypotony.