Foldable Capsular Vitreous Bodies implantation safe and effective method for severe ocular trauma

As the vitreous body is unable to regenerate, an adequate substitute is required to ensure homeostasis of the eye after removing the native vitreous during vitreoretinal surgery. Several artificial vitreous substitutes, such as inert gas, silicone oil (SO), and heavy SO, have been used clinically. However, these vitreous substitutes have several limitations, including short residence time, the elevation of intraocular pressure (IOP), cataracts, emulsification, keratopathy, and secondary glaucoma.

Recently, a new type of foldable capsular vitreous body (FCVB) has been developed for clinical application. It is flexible, effective, and safe as a vitreous substitute and may avoid direct contact with intraocular tissue and reduce complications associated with vitreous substitutes. Therefore, it may be an ideal substitute for the vitreous body in eyes with severe retinal detachment. The purpose of this study by Hao Jiang was to summarize our experience with the application of FCVB in the treatment of severe ocular trauma or SO dependent eyes.

A retrospective analysis was performed on the clinical application of FCVB in the treatment of severe ocular trauma and SO dependent eyes. The results of best-corrected visual acuity and intraocular pressure (IOP) evaluation, B-scan ultrasonography or color Doppler ultrasonography, ultrasound biomicroscopy, and anterior segment photography were recorded during follow-up. A paired t-test was used to compare the difference in IOP before and after FCVB implantation.

Seven eyes of seven patients were included in the 6-month follow-up. In all cases, B-scan ultrasonography and ultrasound biomicroscopy showed that FCVB adapted closely to the globe wall and ciliary body, thus supporting the retina. Visual acuity did not improve, except in one case from LP to HM. The mean ± SD IOP was 8.5 ± 1.90 mm·Hg prior to FCVB implantation and 10.43 ± 0.98 mm·Hg after implantation, with no significant difference between these measurements (P ‑ 0.095). Five of the seven patients developed differing degrees of corneal opacity and keratopathy.

In this study, with the exception of the shallow anterior chamber, no other structural abnormalities were found after FCVB implantation. B-scan ultrasonography revealed that the FCVB was in good contact with the retina and had good retina-supporting function. Furthermore, no retinal detachment was observed during the follow-up.

Ultrasound biomicroscopy showed that the FCVB smoothly contacted the ciliary body with no crushing action. Visual acuity did not improve after FCVB implantation in this study. No significant differences were found in IOP after FCVB implantation, although it was higher postoperatively. Authors did not encounter severe surgical complications during the follow-up period. A cataract was not found as the lens was lost in the primary injury or lensectomy was performed during the par plana vitrectomy surgery in this study. Other complications such as uveitis, vitreous hemorrhage, endophthalmitis, retinal detachment, and SO emulsification were not observed during the observation period.

In summary, FCVB implantation may be a safe and effective method for the treatment of severe ocular trauma or SO dependent eyes. However, FCVB cannot prevent the phthisis of the traumatic eyes. In addition, corneal opacity and keratopathy may be common postoperative complications of FCVBs for eyes with poor ciliary body function and hypotony. Appropriate case selection and proper surgical timing may prevent these side effects. Further studies with larger sample sizes and longer follow-up periods are required to evaluate the clinical efficacy of FCVB implantation.

Source: Hao Jiang , Chao Xue , Yanlin Gao; Hindawi Journal of Ophthalmology Volume 2022,

https://doi.org/10.1155/2022/3608162