The efficacy of intraoperative OCT combined with foldable artificial vitreous balloon (FCVB) implantation in eyes with complex retinal detachment and silicone oil dependence.

OBJECTIVE

To evaluate implantation of a foldable capsular vitreous body (FCVB) in combination with intraoperative optical coherence tomography (I-OCT) for the treatment of complex retinal detachment and silicone oil-dependent eyes.

METHODS

This retrospective study included 10 patients (10 eyes) who underwent third-generation FCVB implantation at the Second Affiliated Hospital of Harbin Medical University. Clinical data, including best-corrected visual acuity (BCVA) and intraocular pressure (IOP), were collected preoperatively and at 1 week, 1 month, 3 months, and 6 months postoperatively. During surgery, I-OCT was employed to dynamically monitor the silicone oil injection volume (ranging from 2.1 to 4.5 mL, based on preoperative axial length and 3D ocular reconstructions), ensuring the posterior FCVB wall adhered to the macular retina with a gap of < 100 μm, and maintaining > 500 μm clearance from the anterior capsule to the iris to preserve the posterior chamber space. Pre-, intra-, and postoperative OCT images of the anterior and posterior segments were compared.

RESULTS

All surgeries were completed successfully without intraoperative complications. I-OCT enabled real-time optimization of silicone oil volume, resulting in tight FCVB-retina adherence (< 50 μm) in 8 of 10 eyes. In 2 trauma-related cases with retinal defects, FCVB adhered directly to the sclera. BCVA showed no significant improvement at 6 months. Two cases experienced elevated IOP at 1 week post-op (34 mmHg and 22 mmHg), both of which normalized after treatment. IOP remained stable (15-22 mmHg) in all eyes at final follow-up.

CONCLUSION

I-OCT provided real-time quantitative feedback that allowed precise control of silicone oil injection, ensured optimal positioning of the FCVB, and reduced postoperative complications. Key intraoperative parameters included (1) real-time silicone oil volume titration, (2) gap measurement between FCVB and retina (< 100 μm), and (3) anterior chamber space evaluation (> 500 μm). The use of I-OCT significantly enhanced surgical precision and enabled individualized treatment planning.