| Objective:To investigate the efficacy and clinical value of ophthalmic endoscopy-guided vitreoretinal surgery in the treatment of chronic hypotony after previous vitrectomy.Methods:This is a prospective non-comparative clinical study.From October 2017 to August 2019,patients with chronic hypotony after previous vitrectomy were treated with ophthalmic endoscopic vitreoretinal surgery in our hospital,selected according to the inclusion and exclusion criteria.The examination of anterior segment photography,fundus photography and ultrasound biomicroscope were applicated preoperatively.The BCVA,intraocular pressure(IOP),cornea,ciliary body and retina were recorded preoperatively,and 1 month,3 months,6 months and the last follow-up respectively postoperatively.The intraoperative situation and postoperative complications were recorded as well.All patients were undergoing vitrectomy,anterior proliferative membrane exfoliation,silicone oil tamponade,retinal photocoagulation and triamcinolone acetonide(TA)injection in vitreous cavity under the guidance of ophthalmic endoscope by one surgeon,intraocular lens extraction or external scleral encirclement in selected eyes.Results:1.The patients’ demographic characteristics:A total of 9 patients(9 eyes)with chronic hypotony were included,with an average age of 45.33±16.18 years(range 20 to 65 years),and an average follow-up was 13.44±4.83 months(range 6 to 22 months).The pre-operative BCVA was light perception～0.05,including light perception(LP)in 1 eye,hand move(HM)in 4 eyes,counter finger(CF)in 3 eyes and 0.05 in 1 eye.The average preoperative IOP was 3.78±1.09 mmHg(range 2 to 5 mmHg),the duration of hypotony was 4.78±3.56 months(range 1 to 12 months),and the average numbers of history ocular surgery was 3.22±0.97 times(range 2 to 5 times).Among them,there were 5 cases(5 eyes)of ocular injuries(3 cases of ocular perforation,2 cases of blunt trauma)and 4 cases(4 eyes)of rhegmatogenous retinal detachment at the first surgery.There were corneal edema or inflammation in 6 eyes before operation,1 eye with obvious Descemet’s membrane striae without corneal edema,and 2 eyes with basically transparent cornea.Before operation,2 eyes were pseudophakia and 7 eyes were aphakia,2 eyes had silicone oil filling in vitreous cavity,7 eyes had absence of vitreous body,2 eyes had extensive ciliary choroidal detachment,2 eyes had tractive superficial retinal detachment less than 1 quadrant,1 eye had posterior polar retinal wrinkles,and the other 4 eyes had no obvious ciliary body and retinal detachment.2.Ophthalmic endoscope observation:Various degrees of aPVR was observed in 9 eyes and proliferative membrane was formed on the surface of ciliary body,ranging from 90°to 360°.The surface of ciliary body uncovered by proliferative membrane showed delicate white velvet-like appearance and brown ciliary body pigment in 5 eyes,along with full ciliary process and regular arrangement.In 3 eyes,the ciliary process atrophied and shrunk,showing a porcelain-white appearance,part of the ciliary body has atrophied obviously and thus makes it difficult to recognize the shape;The ciliary process in 1 eye was completely covered by the proliferative membrane.3.Postoperative follow-up:At the last follow-up,BCVA was improved in 4 eyes(from CF to 0.02,0.05 and 0.1 respectively in 3 eye,from HM to CF in 1 eye),remained unchanged in 4 eyes(0.05 in 1 eye,HM in 2 eyes and LP in 1 eye),and decreased in only 1 eye(from HM to LP).In 1 month,3 months,6 months and the last follow-up period,the average intraocular pressure was 9.89±3.75 mmHg,10.11±4.28 mmHg,8.39±4.18 mmHg and 7.50±3.59)mmHg respectively(P=0.002,0.006,0.041 and 0.007,respectively).A total of 5 eyes underwent silicone oil extraction during the follow-up period,the IOP still higher than pre-operation.At the last follow-up,the retina of 9 eyes were flat,no obvious eye discomfort during the follow-up period,and no eyeball atrophy or enucleation was found in the last follow-up.4.Influencing factors:The postoperative IOP was negatively correlated with the proliferative membrane of ciliary body and the range of ciliary body atrophy.Patients with short duration of hypotony are more likely to have elevated intraocular pressure after surgery.Conclusion:1.Ophthalmic endoscopy-guided vitreoretinal surgery can improve the IOP and visual acuity of patients with chronic hypotony after previous vitrectomy.2.The denser the anterior proliferative membrane of ciliary body,the much wider range and much severer of atrophied ciliary body,and the longer time duration of hypotony,the poorer of the prognosis.3.The application of ophthalmic endoscope can be used as an important auxiliary means for the treatment and management of patients with chronic hypotony. |
