Study on maintenance of eyeball morphology by foldable capsular vitreous body in severe ocular trauma

Abstract

Objectives: To explore the feasibility and safety of using a foldable capsular vitreous body (FCVB) in managing severe ocular trauma and silicone oil-dependent eyes.

Methodology: This is a retrospective study of 61 ocular trauma patients (61 eyes) who presented to the Department of Eye Emergency, Hebei Eye Hospital from May 1, 2018, to May 31, 2019, including 51 male patients (51 eyes) and 10 female patients (10 eyes) with an average age of 44.98 ± 14.60 years old. The oldest patient was 75 years old, and the youngest was 8 years old. These cases represented 51 eyes with severe eyeball rupture and 10 eyes with severe, complicated ocular trauma, which became silicone oil-dependent after the operation. These patients received FCVB implants, and data regarding their visual acuity, intraocular pressure, changes in eye axis, cornea, retina, and FCVB state were recorded after the operation.

Results: In all patients, the FCVB was properly positioned and well supported with the retina. All 61 patients cleared a follow-up window of 1-36 months with no reports of important changes in their visual acuity. Among the patients, 91.8% reported normal intraocular pressure, the retinal reattachment rate reached 100%, and the eyeball atrophy control rate reached 100%. There was no report of rupture of the FCVB, allergies to silicone, intraocular infection, intraocular hemorrhage, silicone oil emulsification, or sympathetic ophthalmia.

Conclusions: Foldable capsular vitreous bodies (FCVBs) designed to mimic natural vitreous bodies are suitable as long-term ocular implants that can provide sustained support for the retina without the need for any special postoperative postures. Their barrier function may effectively prolong the retention time of the tamponade and prevent various complications caused by direct contact of the eye tissues with the tamponade.

Keywords: Foldable capsular vitreous body; Intraocular pressure; Ocular trauma; Retina; Severe case; Visual acuity.

Fig. 1

Structural schema of an FCVB. (a) An FCVB is comprised of a capsule, a drainage tube, and a drainage valve (b) The capsule (inflated)

Fig. 2

Steps of FCVB implantation. (a) Scleral incision construction: 5 mm incision into the limbus followed by a 4-5 mm straight incision, and one 1 mm lateral incision on each side to form an incision of ฺ shape. (b) Push the capsule into the eye via a syringe (c) Inject silicone oil (d) Palpation of the scleral pressure (e) Adjust the capsule position (f) Flush out the blood in the eye (g) Fix the drainage tube (h) Suture the subconjunctival tissue and bulbar conjunctiva

Fig. 3

Images of before/after the FCVB implantation. (a) Conditions of a cornea with inferior limbal rupture before/after the operation (b) Fundus photography after FCVB implantation (c) Orbital CT images before and after FCVB implantation (d) B-scan images before and after FCVB implantation (e) UBM images before and after FCVB implantation