Long-term Follow Up of a Complex Case of Foldable Capsular Vitreous Bag Implantation.

Abstract

Purpose: The Foldable Capsular Vitreous Bag (FCVB) implant is useful in maintaining ocular structure in cases of chronic hypotony secondary to trauma or repeated surgery. There are few published reports of long-term outcomes and no indication of the chronic cellular changes of the adjacent tissues associated with FCVB implantation. We describe one of few FCVB cases in the UK and present histological findings associated with it following secondary enucleation.

Methods: A 33-year-old man underwent a left primary globe repair following a left penetrating injury and intraocular metal foreign body secondary to a close-range blast injury. Postoperatively, a retinal detachment was detected and a left vitrectomy with lensectomy, retinectomy and silicone oil (SO) insertion was performed. Subsequently, pupillary prolene sutures were used to create a two-chamber eye. Despite this, hypotony, SO in the anterior chamber and upper limb deep vein thromboses (DVTs) occurred postoperatively. He had a complex history of Factor V Leiden with renal thrombosis in childhood. After warfarinisation, his FCVB procedure was uneventful with a good bag SO fill.

Results: Post-operative outcomes were initially favourable; however, enucleation was necessary almost three years post-implantation due to spontaneous left hyphaema and intractable raised intraocular pressure. Histology revealed extensive intraretinal fibrotic pannus membranes, loss of photoreceptor architecture and focal foreign body-cell reaction.

Conclusions: A complex case of FCVB implantation following ocular trauma with post-operative complications years later. Long-term outcomes of FCVBs are poorly understood; this case was complicated by the patient's systemic coagulopathy.