Implantation Protocol of the Foldable Capsular Vitreous Body for Complex Vitreoretinal Surgery

Retinal detachment is a severe blinding disorder. Management becomes particularly challenging in cases of complex trauma, multiple recurrences, or eyes requiring longterm intraocular tamponade. Silicone oil is widely used as a vitreous substitute.

However, direct contact with the intraocular tissue may cause emulsification, secondary glaucoma, and corneal endothelial damage. To address these limitations, a Foldable Capsular Vitreous Body was developed. Made of medical-grade silicone rubber, the FCVB encapsulated silicone oil within a capsule, physically isolating from intraocular tissues, and thereby reducing related complications.

This video demonstrates the standardized surgical procedure for FCVB implantation, including preoperative preparation, key surgical steps, and postoperative outcomes. Perform the procedure under general retrobulbar anesthesia according to patient condition and institutional practice. Create conjunctival peritomy at the 10:30 and 4:30 positions.

Using a 9-0 polypropylene suture with a long needle, enter the sclera five millimeter posterior to the limbus at 10:30 and exit four millimeter posterior at 4:30. Construct a scleral tunnel incision two millimeter posterior to the limbus between the 9 and 12 o'clock positions. Before implantation, perform a leakage test by injecting balanced salt solution into the capsule.

Avoid contact between sharp instruments and the device. Evacuate the capsule to create a vacuum while preserving its curvature. Fold the capsule tightly from top to bottom and secure the center temporary with a 5-0 external suture.

Insert the pre-folded device into the vitreous cavity using intraocular lens platform forceps. After approximately half of the capsule has entered the eye, cut the temporary suture and begin silicone oil injection. Tilt the lens-facing surface horizontally using an iris repositor to properly position the device.

Ensure the drainage tube is located at the 10:30 position. Close the scleral tunnel incision with 10-0 nylon sutures. Restore the anterior chamber with viscoelastic.

Secure the fixation sutures using a Z-shaped scleral tunnel. Close the conjunctiva and Tenon's capsule using 8-0 absorbable sutures. Published studies demonstrate that accurate FCVB implantation significantly reduces silicone oil emulsification, secondary glaucoma, and corneal complications compared with conventional silicone oil tamponade.

No cases of phthisis bulbi have been reported in FCVB-treated patients. Postoperative slit-lamp and fundus examinations typically show preserved globe integrity, stable anterior chamber depth, and sustained posterior segment support. When performed correctly, the FCVB remains centrally positioned with capsule collapse, valve leakage, or device migration.

Restoration and maintenance of posterior chamber depth serve as key anatomical indicators of successful implantation. FCVB implantation of the transformative solution for complex retinal detachment and silicone oil-dependent eyes, by isolating silicone oil with a capsule, it significantly enhances long-term intraocular safety. As a refined surgical technique, it requires precise handling and meticulous execution.

This video presents a standardized protocol based on current expert consensus, providing surgeons with practical guidance to preserve the globe in patients at risk of enucleation.