Ciliary epithelium detachment during lens subluxation extraction surgery after blunt eye trauma: A case report

PURPOSE: To document the ciliary epithelial detachment identified intraoperatively during lens-subluxation extraction in a patient with blunt eye trauma. METHOD: A 60-year-old Chinese man presented 14 days after right eye blunt trauma with blurry vision, elevated intraocular pressure (IOP), temporal shallowing of the anterior chamber, and iris bombé 1. To relieve pupillary-block-related IOP elevation, phacoemulsification was performed. Intraoperatively, the lens capsule ruptured, and portions of the nucleus and cortex dropped into the vitreous cavity. The surgeon switched to a cutter to remove the dropped lens material, followed by pars plana vitrectomy. RESULTS: During anterior vitrectomy, a gray-brown bulging tissue at 6 o'clock, consistent with ciliary epithelium, was observed and noted to be tightly adherent. During vitrectomy, an inferior 180° ora serrata dialysis was identified. After complete vitreous removal, fluid-gas exchange, endolaser photocoagulation, and silicone-oil tamponade were performed. Postoperatively, visual acuity progressively improved, and the retina remained attached. CONCLUSION: In blunt ocular trauma, binocular indirect ophthalmoscopy (BIO) with scleral depression is crucial for detecting ciliary epithelium detachment; ultrasound biomicroscopy (UBM) provides adjunctive value but may miss small tears. Intraoperatively, avoid forcibly stripping capsule-like tissue, which may represent ciliary epithelium and risk iatrogenic damage.