Safety and performance assessment of hyaluronic acid‐based vitreous substitutes in patients with phthisis bulbi

Abstract Purpose To assess the safety and performance of hyaluronic acid‐based vitreous substitutes in phthitic eyes. Methods In this retrospective interventional study a total of 21 eyes from 21 patients with phthisis bulbi were treated at the Eye Clinic Sulzbach between August 2011 and June 2021. Patients who underwent a 23G pars plana vitrectomy received a vitreous substitute composed of (I) a non‐crosslinked hyaluronic acid (Healon GV), (II) a crosslinked hyaluronic acid‐based hydrogel (UVHA), or (III) silicone oil (SO‐5000). Main outcome measures were the intraocular pressure (IOP), the visual acuity and the structural integrity of the retina and choroid assessed by optical coherence tomography. Results An increase in IOP ≥ 5 mmHg was achieved with SO‐5000 in 5/8 eyes (6/10 interventions, 60.0%) for 36.4 ± 39.5 days, with Healon GV in 4/8 eyes (7/11 interventions, 63.6%) for 82.6 ± 92.5 days and with UVHA in 4/5 eyes (5/6 interventions, 83.3%) for 93.6 ± 92.5 days. Visual acuity increased in 5/21 eyes (23.8%), remained constant in 12/21 eyes (57.1%) and decreased in 4/21 eyes (19.0%). No enucleations were required during the mean follow‐up time of 192 ± 182 days. The OCT images indicated the preservation of retinal structures, while choroidal folds were only diminished in UVHA eyes. Conclusions Hyaluronic acid‐based hydrogels are biocompatible vitreous substitutes in humans and can increase and stabilize IOP in patients with phthisis bulbi for about 3 months.