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BACKGROUND: Proliferative vitreoretinopathy (PVR) is the leading cause of recurrent retinal detachment. Anterior PVR can contribute to recurrent retinal detachment and is often difficult to remove during conventional pars plana vitrectomy. The purpose of this study is to report surgical outcomes of single endoscopy-assisted pars plana vitrectomy (E-PPV) in patients with tractional retinal detachments associated with anterior proliferative vitreoretinopathy and epiciliary membranes. METHODS: Retrospective review of E-PPV between 2017 and 2021 at a tertiary referral center. Inclusion criteria involved adult patients who underwent E-PPV for tractional retinal detachment with anterior PVR and epiciliary membranes. Data collection included patients' demographics, ophthalmic exam findings, and surgical outcomes. A series of independent sample tests of proportion were conducted using a p-value of 0.05 as the threshold for statistical significance. RESULTS: Eighteen out of 55 patients who underwent E-PPV met the inclusion criteria. There were six females (33%) and 12 males (p-value = 0.096). Age ranged between 27 and 82 years old (mean age 52.1 ± 17.3 years). Nine patients (50%) had a history of ipsilateral retinal detachment repair. Single E-PPV success rate was 100% after three months, and 94.4% at the latest follow up visit. Recurrent retinal detachment with posterior PVR occurred in one patient four months after surgery. Cataract progressed in 57% (8/14) of phakic patients, with 63% (5/8) undergoing cataract extraction surgery within the first postoperative year. CONCLUSION: E-PPV enabled epiciliary membrane and anterior PVR visualization and removal. The single E-PPV success rate remained high at the latest follow up visit. E-PPV enabled the preservation of the phakic lens in all study patients. Larger prospective studies are needed on the role of E-PPV in retina surgeries.

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AIM: To report outcomes of endoscopy-assisted vitrectomy (EAV) in patients with chronic hypotony following severe ocular trauma or vitrectomy. METHODS: This was a retrospective, noncomparative case series. Ciliary bodies were evaluated using ultrasound biomicroscopy pre-operatively and direct visualisation intraoperatively. All selected individuals (seven patients/seven eyes) underwent EAV. Removal of ciliary membrane and traction, gas/silicone oil tamponade (GT/SOT), and scleral buckling (SB) were performed in selected eyes. Outcome measurements mainly included intraocular pressure (IOP) and best-corrected visual acuity (BCVA). RESULTS: Seven eyes from 7 male aphakic patients with a mean age of 45 (range, 20-68)y were included in this study; the average follow-up time was 12 (9-15)mo. GT was performed in 2 eyes; membrane peeling (MP) and SOT in 2 eyes; and MP, SOT, and SB in 3 eyes. The mean pre- and post-operative IOP were 4.5 (range, 4.0±0.11 to 4.8±0.2) mm Hg and 9.9 (range, 5.6±0.17 to 12.1±0.2) mm Hg at 52wk (12mo), respectively. BCVA improved in six eyes; one eye still showed light perception, and no bulbi phthisis was observed. CONCLUSION: Endoscopy offers improved judgment and recognition and has an improved prognosis for chronic hypotony. Therefore, endoscopy can be an effective and promising operative technique for chronic traumatic hypotony management.

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PURPOSE: This study aimed to evaluate treatment outcomes and complications of peripheral circumferential retinal detachment (PCD) after successful vitrectomy. METHODS: Eyes diagnosed with PCD after pars plana vitrectomy (PPV) were retrospectively reviewed. The patient demographic data, complications, management, and treatment outcomes were collected and analyzed. RESULTS: The mean follow-up duration was 18.0 ± 11.9 months. BCVA ranged from light perception to 0.1 (median: counting fingers at 40 cm). Major complications included rubeosis iridis (seven eyes), vitreous hemorrhage (five eyes), hyphema (five eyes), corneal decompensation (three eyes), hypotony (two eyes), and neovascular glaucoma (two eyes). All eyes underwent peripheral retinectomy to remove the detached retina and release traction. Complete retinal reattachment was achieved in all eyes. The final BCVA ranged from hand motion to 0.1 (median: counting fingers at 30 cm). CONCLUSION: PCD may be associated with delayed-onset complications, causing severe loss of vision. Proper management, including peripheral retinectomy, may preserve visual function.

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Purpose: To describe a bimanual technique, "tug of war" for managing anterior circumferential proliferative vitreoretinopathy (PVR) in eyes with recurrent retinal detachment (RRD). Methods: We retrospectively analyzed outcomes from eyes with RRD that underwent reattachment surgery using this maneuver and had a minimum of 6 months follow-up. A chandelier light was inserted for endo-illumination and the circumferential anterior PVR was tackled with two 25-gauge forceps stretching circumferential tractional membranes in opposite direction (tug of war) till they snapped. Results: Eleven eyes of 11 patients with a mean age of 38.2 ± 19.7 years underwent surgery. All eyes had advanced PVR of Grade C A Type 4 (Circumferential). The median duration of RD from the time of first surgery was 6 months (interquartile range = 3-8 months). The tug of war maneuver was successful in relieving the anterior retinal traction leading to retinal reattachment in all eyes without the need for relaxing retinotomies or retinectomies. Small iatrogenic retina tears occurred at the time of tug of war maneuver in 3 (27%) eyes at the site of maximum traction. The mean best-corrected visual acuity (BCVA) improved from 1.87 ± 0.2 logarithm of minimum angle of resolution (logMAR) to 1.3 ± 0.4 logMAR at 6-months follow-up (P = 0.04). Conclusion: The 'tug of war' maneuver is useful for relieving circumferential anterior traction and reattaching the retina in eyes with RRD without having to resort to large relaxing retinotomies or retinectomies.

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BACKGROUND: To describe the dissection and removal of the anterior hyaloid membrane using the conventional surgical microscope. CASE PRESENTATION: This microscopic surgical approach involves dissecting the anterior hyaloid at the natural anatomical plane. A 30-gauge needle mounted on a 3.0 cc syringe is used to inject filtered air anterior to the anterior hyaloid membrane. Two patients needed this procedure; the first patient was pseudophakic with proliferative diabetic retinopathy, tractional retinal detachment, and vitreous hemorrhage. The second patient was phakic with proliferative diabetic retinopathy, anterior proliferative vitreoretinopathy, and recurrent vitreous hemorrhage. Both patients tolerated the procedure well with no complications. CONCLUSION: Pneumatic dissection of the anterior hyaloid membrane is previously thought to be only possible with the aid of ophthalmic endoscopy. This novel surgical approach provides surgeons with the option to perform pneumatic dissection of the anterior hyaloid when ophthalmic endoscopy is not available. Prospective studies are needed to reveal possible additional benefits or risks associated with this approach.

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PURPOSE: Anterior proliferative vitreoretinopathy (PVR) is an important cause of persistent or recurrent retinal detachment (RD). Endoscopy provides 360° panoramic viewing of the vitreous cavity and high-magnification viewing of the anterior vitreous base (AVB). This study describes the 'in vivo' anatomy and pathoanatomy of the AVB using an ocular endoscope in RD and anterior PVR. METHODS: An intraoperative analysis of over 2000 consecutive eyes undergoing vitrectomy for RD operated with endoscopy-assisted vitrectomy was performed. It was recorded in notes dictated during surgery and in standardized operative reports. Around 1500 surgical videotapes, with the exclusion of diabetic retinopathy and trauma, selected by reviewing the OR reports and notes were retrospectively reviewed. RESULTS: Seven endoscopic criteria associated with anterior PVR complicating RD are described: 'en bloc' stiff anterior vitreous retraction, ciliary detachment, seeding of the AVB by abundant pigmented and/or white granulations, anterior tissue displacement, stiff 'wrinkling' at the vitreoretinal juncture, persistent shallow ciliary/RD under perfluorocarbon liquids and traction-related retinal surface haemorrhages. Causes responsible for failure of conventional vitrectomy for RD are highlighted. Findings in case of hypotony and cyclitic membranes are described. CONCLUSIONS: Endoscopy is a significant adjunct to our understanding of the development of anterior loop traction by obviating the two constitutive parts of the AVB, anterior and posterior, their interconnections and their respective connections to the anterior segment and to the retina. It provides a unique evaluation and thorough eradication of the anterior vitreous cortex as a scaffold for anterior PVR. It might be an adjunct to the prevention of anterior PVR.

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AIM: To evaluate the incidence and risk factors of hypotony in patients with blunt ocular trauma. METHODS: The medical records of 145 patients with blunt ocular trauma were reviewed. Hypotony was defined as an average intraocular pressure (IOP) of 5mmHg or less for three times. RESULTS: Among these 145 patients, hypotony was noted in 10 (6.9%) patients. The rate of hypotony in patients with ciliochoroidal detachment was 66.7% (2 out of 3 eyes), and 5.6% (8 out of 142 eyes) in patients without ciliochoroidal detachment, the difference was statistically significant (P=0.003). The rate of hypotony in patients with traumatic retinal detachment was 18.5% (5 out of 27 eyes), and 4.2% (5 out of 118 eyes) in patients without traumatic retinal detachment, the difference was statistically significant (P=0.026). The rate of hypotony in the patients with anterior proliferative vitreoretinopathy was 42.9% (3 out of 7 eyes) and 5.1% (7 out of 138 eyes) in the patients without anterior proliferative vitreoretinopathy, the difference was statistically significant (P=0.002). CONCLUSION: Ocular hypotension is a complication of blunt ocular trauma. The risk factors include ciliochoroidal detachment, traumatic retinal detachment, and anterior proliferative vitreoretinopathy.

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BackgroundAnterior proliferative vitreoretinopathy (aPVR)is a tissue injury and repair progress,and treatment of aPVR is very important in clinic.Chitosan drug delivery system is becoming a hot spot for its large lading dose and long acting duration.ObjectiveThe present study was to investigate the curative effect of a triamcinolone acetonide (TA) drug delivery system after implantation into the suprachoroidal space to treat traumatic aPVR.MethodsaPVR models were created in the left eyes of 65 healthy pigment rabbits by performinga 5 mm penetrating incision 2.5 mm posterior to limbum at 10:30-11:30.The animals were randomly divided into 4groups.Blank chitosan was implanted into the suprachoroidal space as the blank control group.Chitosan with 1 mg TA was implanted in the TA + chitosa group.The TA solution ( containing 1 mg TA) was intravitreally injected in the TA injection group.Fifteen models were used as the traumatic control group.Another 15 left eyes of normal pigment rabbits were used as the normal control group.The thickness of the ciliary tissue was measured using a ultrasound biomicroscope(UBM) 3,5 and 8 weeks after operation.The animals were sacrificed by excessive anesthesia and eyeballswereobtainedforhistopathologicalandultrastructuralexaminations.ResultsHistopathological examination showed the edema of the ciliary tissue and inflammatory cells infiltration in the blank control group,TA injection group and model control group,but mild response was seen in the TA + chitosa group.Severe damage in the ciliary tissue and subcellular organelle was found in the blank and model control groups,but mild damage was detected in the TA + chitosa group under the transmission electron microscope.UBM examination revealed that obvious abnormalities were visible in the ciliary and iris tissue in the blank control group,TA injection group and traumatic control group,but a mild abnormality was seen in the TA + chitosa group.Significant differences in ciliary thickness were exhibited among the 5 groups 2,5 and 8 weeks after operation (F =212.938,515.323,447.919,P＜0.01 ).Compared with the normal control group,ciliary thickness significantly increased in the blank control group and normal control group at various time points (all P＜0.05 ),but that in the TA + chitosa group was significantly lower than the normal control group at various time points ( two weeks:0.484±0.075 vs.0.327 ±0.094 ; five weeks:0.422 ±0.089vs.0.327±0.094 ;eight weeks:0.418±0.085 vs.0.327±0.094) (all P＞0.05). ConclusionsThe chitosan drug delivery system with TA suppresses the excessive proliferation of injured ocular tissue after implantation into the suprachoroidal space,which prevents the formation and development of aPVR.

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Objectives:To establish animal model of anterior proliferative vitreoretinopathy (aPVR) with cultured homologous dermal fibroblasts of rabbit, and to provide evidence why hypotony was caused by aPVR. Methods:Animal models of aPVR were established with cultured homologous dermal fibroblasts on pigmented rabbits. Rabbits were sacrificed on the 14th, 28th and 56th day after the operation to prepare naked eyes and to receive histological examinations. Results:Naked eye examination showed that the peripheral retina was detached by dragging in the experimental group 28 and 56 days postoperatively. Microscopic examination showed atrophy or absence of the non-pigmented ciliary epithelium on the 28th and 56th postoperative day in the experimental group. Conclusions:The epiciliary membrane in aPVR dragged the ciliary body, made atrophy of non-pigmented epithelium, which perhaps was the main cause of hypotony.

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Proliferative vitreoretinopathy is the principal cause of failure in rhegmatogenous retinal detachment surgery. The final cause of anatomic failure is anterior proliferative vitreoretinopathy. Surgical outcome of anterior proliferative vitreoretinopathy is poorer than that of posterior proliferative vitreoretinopathy. Of 147 cases which underwent vitreoretinal surgery from January through December 1993, 16 eyes(l6 patients) had anterior proliferative vitreoretinopathy. Seven eyes had anterior proliferative vitreoretinopathy at initial surgery(group 1). Remaining 9 eyes developed anterior proliferative vitreoretinopathy after primary vitrectomy(group 2). Of 16 eyes, 3 were aphakic, 2 were pseudophakic, and remaining 11 were phakic. Lens was removed in 11 phakic eyes. Meticulous vitreous base dissection and removal of anterior epiretinal membrane were performed. After minimal follow-up of 6 months, retina reattached in 11 eyes(69%) including all nine eyes of group 2. Nine eyes(56%) had postoperative visual acuity of 0.025 or better. These results suggest that both vitreous base dissection and meticulous removal of anterior and posterior epiretinal membrane should be crucial in improving surgical success rate of anterior proliferative vitreoretinopathy.

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We reviewed the records of 23 patients who underwent repeat operation after initial vitreoretinal surgery in Chungnam National University Hospital between January 1993 and December 1993. Of 193 eyes who underwent vitreoretinal surgery in that period, 23(12%) had undergone reoperation. The most common cause of initial anatomic failure and reoperation was either new or recurrent proliferative vitreoretinopathy(10 eyes). Other causes included iatrogenic retinal tears(5 eyes), hidden retinal breaks(4 eyes), vitreous traction(1 eye), inappropriate chorioretinal adhesion(1 eye), and new break(1 eye). We performed vitreous base dissection on all 9 eyes with anterior proliferative vitreoretinopathy. With additional surgery and after a mean follow-up period of 10.4 months, 21(91%) of 23 retinas were reattached. The final cause of anatomic failure was anterior proliferative vitreoretinopathy. Of the 23 reoperated eyes, 20(87%) had postoperative visual acuity of 0.05 or better.

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Objective To study the changes in the activity of two important enzymes related to the productivity of aqueous humor, namely Na +-K +ATPase and carbonic anhydrase, and to probe further into the mechanism of induction of chronic ocular hypotony by traumatic anterior proliferative vitreoretinopathy. Methods A rabbit model of chronic hypotony induced by traumatic anterior proliferative vitreoretinopathy was reproduced. At the 2nd , 4th, 8th and 16th week after trauma, IOP was measured. Then eyeballs were removed, and a part of ciliary body was harvested for orthodox pathological section and HE staining, and another part of ciliary body was used for determination of Na +-K +ATPase's activity and histochemical assessment of carbonic anhydrase. Result Activity of Na, K-ATPase decreased gradually in the experimental group, but there is no remarkable change in the control group, and the difference was significant. In the experimental group, the activity of carbonic anhydrase was nearly normal, but the activity of carbonic anhydrase in the area of injured epithelium was low, and it was similar to the control. Conclusion Activity of ciliary Na +-K +-ATPase and carbonic anhydrase decrease in activity after traumatic anterior proliferative vitreoretinopathy, which is an important causative factor of chronic hypotony.

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Objective To study the dynamics of aqueous humor in chronic hypotony induced by traumatic anterior proliferative vitreoretinopathy (aPVR), and to demonstrate physiologic mechanisms of the hypotony. Methods A model of hypotony to simulate traumatic aPVR was reproduced in rabbits. Preoperatively and on day 7, 14, 28 and 56 postoperatively, the aqueous humor flow rate and the uveoscleral outflow of aqueous humor were determined. Results The flow rate of aqueous humor in experimental group was reduced remarkably compared with that of control group on days 14, 28 and 56 (P

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Objective To study the occurrence, development and outcome of hypotony following traumatic anterior proliferative vitreoretinopathy (aPVR), so as to provide a theoretical basis for its prevention and treatment. Methods An animal model of chronic hypotony following traumatic aPVR was reproduced in rabbits. The intraocular pressure (IOP) was measured before the experiment and on days 7, 14, 28 and 56 after the injury. Rabbits were killed on days 14, 28 and 56 after the experiment, prepared for pathological and ultrastructure examination. Results The average IOP of experimental group was significantly lower than that of control group on days 7, 14, 28 and 56 (p