The efficacy of intraoperative OCT combined with foldable artificial vitreous balloon (FCVB) implantation in eyes with complex retinal detachment and silicone oil dependence

Abstract

Objective: To evaluate implantation of a foldable capsular vitreous body (FCVB) in combination with intraoperative optical coherence tomography (I-OCT) for the treatment of complex retinal detachment and silicone oil-dependent eyes.

Methods: This retrospective study included 10 patients (10 eyes) who underwent third-generation FCVB implantation at the Second Affiliated Hospital of Harbin Medical University. Clinical data, including best-corrected visual acuity (BCVA) and intraocular pressure (IOP), were collected preoperatively and at 1 week, 1 month, 3 months, and 6 months postoperatively. During surgery, I-OCT was employed to dynamically monitor the silicone oil injection volume (ranging from 2.1 to 4.5 mL, based on preoperative axial length and 3D ocular reconstructions), ensuring the posterior FCVB wall adhered to the macular retina with a gap of < 100 μm, and maintaining > 500 μm clearance from the anterior capsule to the iris to preserve the posterior chamber space. Pre-, intra-, and postoperative OCT images of the anterior and posterior segments were compared.

Results: All surgeries were completed successfully without intraoperative complications. I-OCT enabled real-time optimization of silicone oil volume, resulting in tight FCVB-retina adherence (< 50 μm) in 8 of 10 eyes. In 2 trauma-related cases with retinal defects, FCVB adhered directly to the sclera. BCVA showed no significant improvement at 6 months. Two cases experienced elevated IOP at 1 week post-op (34 mmHg and 22 mmHg), both of which normalized after treatment. IOP remained stable (15-22 mmHg) in all eyes at final follow-up.

Conclusion: I-OCT provided real-time quantitative feedback that allowed precise control of silicone oil injection, ensured optimal positioning of the FCVB, and reduced postoperative complications. Key intraoperative parameters included (1) real-time silicone oil volume titration, (2) gap measurement between FCVB and retina (< 100 μm), and (3) anterior chamber space evaluation (> 500 μm). The use of I-OCT significantly enhanced surgical precision and enabled individualized treatment planning.

Keywords: Complex retinal detachment; Foldable capsular vitreous body; Silicone oil-dependent eyes.

Fig. 1

Patient selection flowchart

Fig. 2

Postoperative IOP during follow-up examinations

Fig. 3

Representative ocular imaging in Case 1 with retinal detachment treated by FCVB implantation. Preoperative OCT (A) revealed extensive retinal detachment involving the macular region. Preoperative SLO imaging (B) showed a large area of chronic rhegmatogenous retinal detachment affecting three quadrants, with several large retinal tears observed between the 3 and 6 o’clock positions in the inferonasal retina. Intraoperative I-OCT (C) demonstrated effective macular reattachment under FCVB tamponade, with close apposition between the capsule and the retina and no evidence of excessive compression. Intraoperative anterior segment I-OCT (D) showed that the anterior surface of the FCVB maintained a safe distance from the iris, preserving the posterior chamber space.At one week postoperatively, OCT (E) showed good macular reattachment with no excessive compression from the FCVB capsule. Corresponding SLO imaging (F) confirmed complete retinal reattachment and well-sealed retinal breaks, with a small amount of subretinal hemorrhage observed in the peripheral retina. At one month postoperatively, OCT (G) indicated stable macular reattachment and maintained relative positioning between the FCVB capsule and the retina. SLO imaging (H) demonstrated continued retinal reattachment with partial absorption of the subretinal hemorrhage. Anterior segment OCT (I) revealed apposition of the anterior surface of the FCVB to the iris and a normal anterior chamber depth

Fig. 4

Representative ocular imaging in Case 5 with retinal detachment treated by FCVB implantation.(A) Preoperative OCT shows retinal detachment involving the macular region. (B) Preoperative SLO reveals a large retinal tear near the nasal ora serrata, with detachment involving three quadrants and the macula. (C) Intraoperative I-OCT demonstrates close apposition between the FCVB and retina without excessive compression. (D) Intraoperative anterior segment I-OCT shows that the anterior surface of the FCVB does not compress the iris, and the anterior chamber is preserved. (E) One week postoperatively, OCT shows good macular reattachment with no signs of FCVB-induced compression. (F) SLO at one week shows complete retinal reattachment in the posterior pole and mild subretinal hemorrhage in the mid-peripheral area. (G) Anterior segment OCT shows normal anterior chamber depth.(H) One month postoperatively, OCT confirms stable macular reattachment. (I) SLO shows significant absorption of subretinal hemorrhage and a well-positioned posterior pole. (J) Anterior segment OCT shows a slightly shallow anterior chamber