Evaluation of supporting role of a foldable capsular vitreous body with magnetic resonance imaging in the treatment of severe retinal detachment in human eyes

Abstract

Purpose: To determine the supporting role of a novel foldable capsular vitreous body (FCVB) with magnetic resonance imaging (MRI) in the treatment of severe retinal detachment in human eyes.

Methods: The study examined nine eyes of nine patients. Among the nine eyes, five had suffered penetrating injuries while four had suffered contusions of the eyeball involving large defects of the retina or choroids. A standard three-port pars plana vitrectomy was performed, FCVB was triple-folded and sent into the vitreous cavity; balanced salt solution (BSS) was injected into the capsule to support the retina. Three cardinal axes of nine eyes were examined using MRI at baseline and at the 3-month follow up.

Results: MRI revealed that the signal intensity of the FCVB was similar to the normal vitreous body, with low-signal intensity on T1-weighted image and high-signal intensity on T2-weighted image. In three pre-operative silicone oil- or heavy silicone oil-filled eyes, FCVBs were not fully inflated, and eyeball deformation was observed in one eye. Shifts of three cardinal axes of three eyes (horizontal, anteroposterior, and vertical) according to MRI, were -4.33, -4.67, and -2.67 mm. In the remaining six eyes, FCVBs were well distributed in the vitreous cavity and evenly supported the retina; the cardinal axes of the eyes were similar to pre-operation. Shifts of three cardinal axes of six eyes were -0.34, -0.34, and -0.34 mm. In a total of nine eyes, shifts of three cardinal axes were -1.67, -1.77, and -1.11 mm. Statistically significant difference showed only between the horizontal axis of nine eyes pre-operatively and post-operatively (P1=0.041, P2=0.058, P3=0.123).

Conclusion: This study demonstrated the effectiveness of MRI to monitor the supporting role of an FCVB in the treatment of severe retinal detachment in human eyes.

Figures

Figure 1

Anterior segment photography, B-scan of case 9 and graded scores of visual acuity during a 3-month implantation period. There was no statistically significant conjunctival congestion, corneal oedema, keratic precipitate, or aqueous flare at 3 months after FCVB implantation. The B-scan showed that a capsule-like arc reflective signal was supporting the retina (arrow). The graded scores of visual acuity at each time point after FCVB implantation do not show a significant difference compared with those at baseline.

Figure 2

MR images of FCVB in vitro. The FCVB full of BSS appeared as a round object with high-signal intensity on T2-weighted image. The signal intensity of FCVB was similar to that of the normal vitreous body, and three cardinal axes of the FCVB could be measured accurately.

Figure 3

T2-weighted fat-suppressed image of case 5. (a) MRI showed that silicone oil was only filling two-thirds of the vitreal cavity. When the patient reclined, silicone oil floated above the water, leaving the inferior retina unsupported. Interface of silicone oil and water was clearly observed. (b) In this patient, the FCVB was not fully inflated.

Figure 4

T2-weighted fat-suppressed image of case 3. (a) MRI showed silicone oil fully filled the vitreal cavity, while severe retinal detachment was observed. The funnel-shaped shadow in the eye was the detached retina. (b) An FCVB was fully inflated to support the retina adequately during a 3-month implantation.

Figure 5

T2-weighted fat-suppressed image of case 7. (a) MRI showed the detached retina floating in the vitreal cavity after heavy oil implantation. The bright line in the eye was the detached retina. (b) An FCVB was fully inflated to support the retina adequately during a 3-month implantation.

Figure 6

T2-weighted fat-suppressed image of case 4. (a) MRI showed the retina detachment, subretinal haemorrhage, and lack of lens. (b) An FCVB was fully inflated to support the retina adequately during a 3-month implantation.

Figure 7

Histogram of three cardinal axes of eyes (horizontal, anteroposterior, and vertical) using MRI. In three pre-operative silicone oil- or heavy silicone oil-filled eyes, shifts of three cardinal axes of three eyes (horizontal, anteroposterior, and vertical) using MRI were −4.33, −4.67, and −2.67 mm. In the remaining six eyes, shifts of three cardinal axes of six eyes were −0.34, −0.34, and −0.34 mm. Among the total nine eyes, shifts of three cardinal axes according to MRI were −1.67, −1.77, and −1.11 mm. There was statistically significant difference only between the horizontal axis of nine eyes pre-operatively and post-operatively (P1=0.041, P2=0.058, P3=0.123).