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Rachel Tandias, Peng Sun, Luke Campo, John Campo, Jorge G Arroyo; Endoscopy-assisted ciliary body membrane peeling is an effective treatment for hypotony secondary to rhegmatogenous retinal detachment repair. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5919.
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Hypotony is defined as intraocular pressure (IOP) at or below 5 mmHg and is a relatively common postoperative complication after extensive vitreoretinal surgery. Restoration of normal IOP, either by pharmacologic or surgical treatment, remains challenging. This retrospective, observational study evaluated the therapeutic effects of endoscopy-assisted ciliary body membrane peeling for chronic hypotony after rhegmatogenous retinal detachment (RRD) repair.
This retrospective review included 19 patients (19 eyes) diagnosed with chronic hypotony following surgery for RRD between 2004 and 2017. Chronic hypotony was defined as an IOP of 5 mmHg or less for at least 1 month. All patients underwent endoscopic vitrectomy with removal of ciliary body membranes from the ciliary processes. Patients were followed for a minimum of 3 months (average: 14.1 months). Primary outcome measurements included final IOP, visual acuity (VA), and development of postoperative complications.
Mean number of previous vitreoretinal surgeries was 1.9 (range 1-3). Thirteen eyes (68%) had silicone oil tamponade at the time of endoscopic surgery. Mean IOP increased significantly from 3.27±2.27 mmHg preoperatively to 9.82±3.97 mmHg at the last postoperative visit (p<0.001). Final IOP was greater than 5 mmHg in 14 of the 19 eyes (74%). Factors associated with higher postoperative IOP included shorter hypotony duration, absence of prior retinectomy, greater range of ciliary body membrane peeling, and presence of un-reattached retinal detachment at the time of endoscopic vitrectomy. Mean visual acuity did not change significantly after surgery. Two eyes developed phthisis, 3 eyes developed silicone oil filling the anterior chamber, and 2 eyes required additional surgery for ciliary body membrane peeling for persistent hypotony. No eyes underwent enucleation or evisceration.
As demonstrated by this case series, endoscopy-assisted ciliary body membrane peeling can increase IOP and stabilize visual acuity in eyes with chronic hypotony after surgical RRD repair. The duration of hypotony, previous retinectomy, incomplete retinal reattachment at the time of endoscopic surgery, and range of ciliary body membrane peeling are possible indicators for IOP prognosis. Further study is necessary to evaluate long-term outcomes and differences among available treatments.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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