ENDOSCOPY FOR EVALUATION AND TREATMENT OF THE CILIARY BODY IN HYPOTONY AND OTHER VISUALIZATION PROBLEMS DURING VITRECTOMY

Mark Hammer, W. S. Grizzard (Tampa)

Purpose: To determine the usefulness of the endoscope for visual evaluation of the ciliary body (CB) in eyes with hypotony and as a visualization tool for surgery of ciliary body membranes in eyes with hypotony and for surgery with other difficult visualization problems.

Method: A gradient index of refraction rod endoscope was used to evaluate the ciliary body in 14 patients with hypotony. Videotapes and charts were reviewed retrospectively to correlate the appearance of the CB, clinical findings, and surgical results Videoendoscopic surgery to remove fibrous tissue from the ciliary processes was performed in nine eyes. Other patients with endophthalmitis, silicone IOL condensation during air-fluid exchange, and loss of posterior view during air-fluid exchange for other reasons also are demonstrated.

Results: The endoscope produced a clear detailed image of the ciliary body in a state that is undisturbed by scleral depression or other forms of mechanical distortion. White surface changes in the peak and crest of individual ciliary processes (white-caps) were seen in 11 of 14 patients with hypotony. Other findings in hypotony were fibrous investment of the ciliary body in 10 patients, loss of pigment epithelium in 5, traction elongation of the ciliary processes in 8, vascular loops in 4, pigmented sheets in 3, and areas of missing ciliary processes in 1. Whitecaps were present in 7 of the 9 patients who had surgery for fibrous traction of the ciliary processes and hypotony, and 3 patients with hypotony not due to other endoscopically visible abnormalities of the ciliary processes. Endoscopically visualized dissection of ciliary body in 9 patients resulted in normal or elevated tension immediately postoperatively in seven (78 %). Surgical technique to perform vitrectomy surgery in endophthalmitis and various cases where loss of visualizatiuon due to anterior segment degradation of the microscopic view is demonstrated.

Conclusion: The endoscope is a valuable tool for evaluation and management of hypotony and other posterior segment diseases. Using the endoscope new clinical findings of whitecaps and traction elongation of the ciliary processes were found in cases of hypotony. The endoscope facilitated surgery for dissection and removal of fibrous tissue over the CP and for the performance and completion of more routine vitrectomy.


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