Consequence of Chronic Hypotony Phthisis5

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The difference between an eye in "prephthisical" vs "phthisical" stage is that in the latter, tissue disruption is evident; the condition results from the cessation of aqueous production. If treatment of all known pathologies, including that of anterior PVR,6 has been exhausted and the eye starts to shrink, there are two options left besides eye removal (see below).

3 This is the clinician's observation; there is no explanation for the phenomenon in the available literature.

4 Major iris damage is an indicator of ciliary body trauma (see Chap. 2.6).

5 The term means "wasting away".

6 Meticulous removal of membranes covering the ciliary body should be attempted even in late cases. The phthisis is not reversible but stoppable if the intervention was not too late - but this can be determined only after the attempted scar removal has failed, and should not serve as an excuse not to attempt scar removal.

Fig. 2.19.1 Intraoperative image of repair for ciliary body destruction. This 8-year-old boy had a rupture with vitreous hemorrhage. He underwent several surgeries and eventually the eye was given up on. He developed iris scarring into the wound; there was no pupil, the retina was detached, the visual acuity was light perception, and the axial length of the previously emmetropic eye was 21 mm. After a pupil was created, the ciliary body was debulked, the pre-and subretinal scars were removed, and silicone oil was implanted (restricted to the vitreous cavity). There was no anterior PVR. The most probable explanation for the partial destruction of the ciliary processes (arrow) is that the posterior lens capsule was not removed originally. Twelve months after surgery, the IOP is normal, the eye has stopped shrinking, the retina is attached, and the visual acuity has improved to 20/40

Fig. 2.19.1 Intraoperative image of repair for ciliary body destruction. This 8-year-old boy had a rupture with vitreous hemorrhage. He underwent several surgeries and eventually the eye was given up on. He developed iris scarring into the wound; there was no pupil, the retina was detached, the visual acuity was light perception, and the axial length of the previously emmetropic eye was 21 mm. After a pupil was created, the ciliary body was debulked, the pre-and subretinal scars were removed, and silicone oil was implanted (restricted to the vitreous cavity). There was no anterior PVR. The most probable explanation for the partial destruction of the ciliary processes (arrow) is that the posterior lens capsule was not removed originally. Twelve months after surgery, the IOP is normal, the eye has stopped shrinking, the retina is attached, and the visual acuity has improved to 20/40

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