Background: Low intraocular pressure due to ciliary body dissection or detachment is known to be caused by injury and iatrogenicity. Although previous studies have reported ciliary detachment after 20-gauge and 25-gauge vitrectomy, there have been no reports on ciliary detachment after 27-gauge vitrectomy.
Case: A 76-year-old woman was referred to our hospital because of decreased vision in her left eye. The best corrected visual acuity at initial visit was hand movement at 20 cm in the left eye, and intraocular pressure was 13 mmHg. The patient had a vitreous hemorrhage in the left eye and underwent 27-gauge pars plana vitrectomy (PPV). Intraoperative findings revealed varicose veins and extensive retinal hemorrhage in all four quadrants, leading to a diagnosis of vitreous hemorrhage caused by central retinal vein occlusion. On the first day after surgery, a slight vitreous hemorrhage and macular edema were observed, and anti-vascular endothelial growth factor (VEGF) agents were intravitreally injected. However, the vitreous hemorrhage worsened and low intraocular pressure (4 mmHg) was observed 3 weeks after surgery. Ultrasonography showed neither retinal detachment nor choroidal detachment. Ciliary body imaging using anterior segment optical coherence tomography showed ciliary detachment in four quadrants. Therefore, 27-gauge PPV combined with 20% sulfur hexafluoride gas tamponade was performed. The patient was instructed to remain in the supine position postoperatively, and the ciliary detachment rapidly disappeared. However, when the positional restriction was lifted after discharge, the low intraocular pressure and ciliary detachment recurred. Instruction to keep supine position again resulted in the disappearance of ciliary detachment and increase in intraocular pressure.
Conclusions: We report a case of ciliary detachment after 27-gauge minimally invasive vitrectomy. We should consider that persistent low intraocular pressure after 27-gauge minimally invasive vitrectomy may be caused by ciliary detachment.
Nippon Ganka Gakkai Zasshi (J Jpn Ophthalmol Soc) 126: 581-587,2022.