{"paper_id":"21fca3bb-67a9-47ad-9664-beed19de1592","body_text":"Endoscope-assisted vitrectomy for severe ocular trauma with corneal blood staining and no light perception: A clinical efficacy analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Endoscope-assisted vitrectomy for severe ocular trauma with corneal blood staining and no light perception: A clinical efficacy analysis Youyou Zha, Susie Du, Kun Wang, Haiya Fang, Jing Gong, Keju Chen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8631674/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To evaluate the clinical characteristics and therapeutic efficacy of endoscope-assisted vitrectomy (EAV) for severe ocular trauma complicated by corneal blood staining and no light perception (NLP). Methods A retrospective study was conducted on 23 eyes of 23 patients with severe ocular trauma, corneal blood staining, and NLP who underwent EAV. Among them, 21 eyes were complicated by retinal detachment (RD), and 2 eyes had corneal laceration. The mean interval from injury to surgery was 20.43 days (range, 5 to 64 days). Preoperatively, all eyes had NLP with a mean intraocular pressure (IOP) of 9.9 mmHg (range, 2 to 37.4 mmHg). The mean follow-up period was 8.62 months (range, 0.1 to 45 months). Results Postoperative visual acuity was significantly improved compared with preoperative levels (P < 0.05). Visual acuity recovered to light perception or better in 13 eyes (56.5%), with the best corrected visual acuity reaching 0.7 in one eye. Anatomical retinal reattachment was achieved in 10 of the 21 eyes (47.6%) with preoperative RD. The mean postoperative IOP was 12.50 mmHg (range, 5 to 24 mmHg), which was significantly higher than the preoperative mean (P < 0.05). Conclusion Endoscope-assisted vitrectomy is a safe and effective technique for managing severe ocular trauma with corneal blood staining and NLP. It facilitates visual function recovery and may help reduce the risk of phthisis bulbi. Endoscope-assisted vitrectomy Severe ocular trauma Corneal blood staining Retinal detachment No light perception Introduction Corneal blood staining results from the deposition of hemoglobin and its breakdown products into the corneal stroma following hyphema [ 1 – 2 ] . Its reported incidence after traumatic hyphema ranges from 2% to 11% [ 3 – 5 ] . The presence of corneal blood staining significantly obscures the surgical field, complicating conventional pars plana vitrectomy (PPV) [ 6 ] . Traditional management options for severe ocular trauma with NLP and corneal blood staining have often been limited to enucleation or combined procedures involving temporary keratoprosthesis, vitrectomy, and penetrating keratoplasty. These approaches are not only technically complex and costly but also dependent on donor cornea availability [ 7 ] . While mild corneal blood staining may resolve spontaneously and conjunctival flaps can provide symptomatic relief [ 8 ] , delaying vitrectomy until corneal clearing risks losing the optimal window for intraocular intervention, potentially leading to irreversible damage. Endoscope-assisted vitrectomy (EAV) offers a distinct advantage by enabling direct visualization of intraocular structures despite corneal opacity, allowing for precise removal of pathologic tissues, retinal reattachment, and minimizing the risk of iatrogenic injury to detached retina and choroid [ 9 ] . This study aimed to analyze the clinical features of severe ocular trauma with NLP complicated by corneal blood staining and to evaluate the efficacy and safety of EAV in this challenging patient population. Methods Study Participants A retrospective review was performed on the clinical records of 23 patients (23 eyes) with severe ocular trauma, NLP, and corneal blood staining who underwent EAV by the same surgeon between June 2005 and October 2021 at Beijing Tongren Hospital, Chengdu Aier Eye Hospital, and Suzhou Lixiang Eye Hospital. All patients were male, with ages ranging from 10 to 57 years (mean, 36 years). The types of ocular injuries included globe rupture (17 eyes, 73.9%), penetrating injury (4 eyes), closed ocular blunt trauma (1 eye), and intraocular foreign body injury (1 eye). Preoperative Evaluation All affected eyes had NLP preoperatively. The preoperative IOP was below 10 mmHg in 12 eyes, below 6 mmHg in 8 eyes, and above 21 mmHg in 1 eye. Retinal detachment was present in 21 eyes, and choroidal detachment was noted in 14 eyes. Surgical Technique All surgeries were performed under general anesthesia. The surgical approach was selected based on preoperative assessment: a corneal approach was used in 20 eyes, and a pars plana approach was employed in 3 eyes. When present, existing corneal lacerations were utilized as ports for the endoscope or instruments. Under direct endoscopic visualization, intraocular hemorrhage and vitreous were removed. The proliferative membranes were meticulously peeled off. Perfluorocarbon liquid was used to flatten and reattach the retina. If choroidal detachment persisted after the injection of perfluorocarbon liquid, a posterior sclerotomy was performed to drain the subretinal fluid. Retinal incisions were made for any identified retinal constrictions. All confirmed retinal breaks were treated with laser photocoagulation. Laser photocoagulation was also applied to the incised peripheral retina and the areas of exposed retinal pigment epithelium. During the operation, either gas tamponade or silicone oil tamponade was selected based on the retinal condition. If the initial volume of injected silicone oil was less than 4.5 mL, continuous silicone oil injection was performed to ensure adequate tamponade effect [ 11 ] . Follow-up and Outcome Measures Postoperative follow-up ranged from 0.1 to 45 months. Evaluations included assessments of visual acuity, IOP, and intraocular status. Visual acuity was converted to logMAR units for analysis: 3.2 for NLP, 2.9 for light perception (LP), 2.6 for hand motions (HM), and 2.3 for counting fingers (CF) [ 12 ] . Statistical Analysis Data analysis was performed using SAS software (version 9.4). Continuous variables are presented as mean ± standard deviation or range, as appropriate. Comparisons between preoperative and postoperative parameters were made using paired t-tests. A P value of less than 0.05 was considered statistically significant. Results Visual Acuity Outcomes Postoperatively, visual acuity improved to LP or better in 13 eyes (56.5%). One eye achieved a best corrected visual acuity of 0.7. The improvement in visual acuity from preoperative levels was statistically significant (P < 0.05). Intraocular Pressure Changes The mean postoperative IOP was 12.50 mmHg (range, 5 to 24 mmHg), which represented a significant increase from the preoperative mean of 9.9 mmHg (P < 0.05). In the subgroup of eyes with a preoperative IOP below 6 mmHg, the mean postoperative IOP increased to 11.5 mmHg (P < 0.05). Transient postoperative IOP elevation to 24 mmHg occurred in one eye and was controlled with topical medication. One eye had a low postoperative IOP of 5 mmHg. Retinal Reattachment Status Anatomical reattachment of the retina was achieved in 10 of the 21 eyes (47.6%) with preoperative RD. For the remaining 11 cases, intraocular observation was not possible due to corneal opacity. Comparison of Surgical Approaches No statistically significant differences were observed between the corneal and pars plana approaches regarding the postoperative retinal reattachment rate (P = 0.59), visual acuity recovery (P = 0.89), or IOP changes (P = 0.62). Corneal Management and Outcomes A conjunctival flap was performed postoperatively in 3 eyes. The flaps were removed after a mean period of 15 months, resulting in corneal clearing. At the final follow-up examination, 5 eyes had clear corneas. Complications and Secondary Procedures Secondary silicone oil removal was performed in 2 eyes. During the follow-up period, silicone oil-related corneal leucomas were observed in 4 eyes. No instances of secondary glaucoma, iatrogenic retinal breaks, or intraocular hemorrhage were noted. Five eyes developed phthisis bulbi from persistent hypotony: 1 underwent enucleation, and 4 were followed up continuously. Discussion Conventional pars plana vitrectomy (PPV) is significantly challenging in eyes with severe trauma presenting with NLP and corneal blood staining due to the obscured surgical view. In this context, endoscope-assisted vitrectomy (EAV) demonstrated several advantages in our case series based on its inherent technical features. First, in traditional PPV, corneal pathology such as edema, laceration, scarring, and blood staining often necessitates the initial placement of a temporary keratoprosthesis, followed by combined corneal transplantation. This strategy is not only procedurally complex but also carries risks including graft rejection, astigmatism, and graft opacification (with reported rates of approximately 43% at one year and 57% beyond two years postoperatively) [ 13 ] . In contrast, EAV allows direct visualization of intraocular structures independent of corneal clarity. This is particularly beneficial in cases complicated by conditions like endophthalmitis that require urgent intervention, where the cornea may regain transparency spontaneously after inflammation subsides, usually within about two weeks. EAV thus provides a feasible approach for its performance within an optimal surgical window. In our series, visual acuity recovered to better than LP in 56.5% of eyes postoperatively, suggesting that this technique can aid in visual pathway reconstruction under complex anatomical conditions. Second, severe ocular trauma is frequently associated with retinal or choroidal detachment. During conventional PPV, limited visualization increases the risk of iatrogenic damage to detached tissues and may even lead to infusion fluid or silicone oil entering the subchoroidal space. EAV, guided by the endoscope, provides clear delineation of anatomical planes. The corneal approach further allows surgeons to effectively circumvent anteriorly detached choroid, thereby reducing the risk of iatrogenic injury. Our results demonstrated anatomical reattachment in 47.6% (10/21) of eyes with preoperative retinal detachment (RD), with a significantly higher mean postoperative intraocular pressure (IOP) than preoperatively (P < 0.05). Intraoperative confirmation of retinal detachment was obtained in 21 cases, while retinal status could not be visualized due to corneal opacity in 11 of the cases. These findings indicate a positive role for EAV in restoring structural stability to the globe. Furthermore, The nearly unlimited field of view provided by the endoscope facilitates the examination of the ora serrata and ciliary body region, which is advantageous for managing peripheral proliferative pathology and detecting occult foreign bodies [ 14 ] . This capability is particularly important for addressing acute proliferative vitreoretinopathy (aPVR), a common sequela of trauma, and may contribute to reducing the incidence of postoperative complications such as hypotony. Phthisis bulbi occurred in 5 eyes (21.7% incidence) of this cohort. All 5 cases had severe intraoperative choroidal lacerations and a relatively long injury-to-treatment interval, both factors contributing to phthisis bulbi. The management of corneal blood staining involves balancing the timing and modality of intervention. In our cohort, three eyes that underwent postoperative conjunctival flap coverage eventually achieved corneal clarity, indicating that this method can be an effective adjunct for promoting blood stain resolution in selected patients. It is noteworthy that silicone oil tamponade was maintained long-term in most of our cases. Although corneal leucomas associated with silicone oil were observed in four eyes, no serious complications like secondary glaucoma occurred. This suggests that silicone oil filling retains clinical value in maintaining globe integrity and residual function in such complex injuries. Certainly, endoscopic systems have inherent limitations [ 15 ] , including the lack of stereoscopic vision, high demands on hand-eye coordination, and a associated learning curve [ 16 – 18 ] . The absence of serious complications like iatrogenic retinal breaks in our series may be attributable to the surgeon's experience and meticulous technique. With the ongoing development of new technologies such as three-dimensional heads-up display systems [ 19 ] , the precision and safety of endoscopic surgery are expected to improve further. Limitations This study has several limitations, including its retrospective design, relatively small sample size, and heterogeneity in both injury patterns and follow-up durations. Future prospective studies with larger cohorts are warranted to further validate the efficacy and safety of EAV for managing this complex subset of ocular trauma. Conclusion Endoscope-assisted vitrectomy appears to be a safe and effective surgical option for severe ocular trauma with NLP complicated by corneal blood staining. It promotes visual recovery, helps maintain IOP, and may reduce the risk of phthisis bulbi. The corneal approach is particularly suitable for cases with associated anterior choroidal detachment. Conjunctival flap coverage can serve as a useful adjunctive measure to facilitate corneal clearing in patients with blood staining. Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Ethics Review Committee of Lixiang Eye Hospital of Soochow University (Approval No: SLER2026150). The requirement for informed consent was waived by the committee due to the retrospective nature of the study and the use of fully anonymized data. All data were pseudonymized to protect patient privacy. As an observational study, it was exempt from clinical trial registration. No patients or the public were involved in the design, conduct, or reporting of this research. The datasets generated and analyzed are available from the corresponding author upon reasonable request. Consent for publication Not applicable Competing interests The authors declare no competing interests. Funding None Author Contribution The authors’ responsibilities were as follows. Y.Z and S.D. collected the clinical data and performed the surgical procedures. K.W. and H.F. conducted the statistical analysis. J.G. assisted with data curation and literature review. Y.Z and K.C. drafted the initial manuscript. X.Y. conceived and designed the study, supervised the entire project, and critically revised the manuscript. All authors reviewed and approved the final version for publication. Acknowledgements None Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References Kiziltoprak H, Atesoglu Hİ, Tekin K, Yetkin E, Koc M. Evaluation of Densitometric Analysis for Early Detection of Corneal Blood Staining in Hyphema. Cornea. 2021;40(4):467–471. doi: 10.1097/ICO.0000000000002451. PMID: 32740008. Woreta FA, Lindsley KB, Gharaibeh A, Ng SM, Scherer RW, Goldberg MF. Medical interventions for traumatic hyphema. Cochrane Database Syst Rev. 2023;3(3):CD005431. 10.1002/14651858.CD005431.pub5 . PMID: 36912744; PMCID: PMC10010597. Liebman DL, Aboobakar IF. Traumatic Hyphema: Diagnostic and Management Considerations. Int Ophthalmol Clin. 2024;64(2):49–61. doi: 10.1097/IIO.0000000000000490. Epub 2024 Mar 25. PMID: 38525981. Genadry KC, Shrock C, O'Shea D, Vatsa R, Shah AS, Gise R, Lipsett SC. Traumatic Hyphema. J Emerg Med. 2021;61(6):740–741. 10.1016/j.jemermed.2021.07.041 . Epub 2021 Sep 11. PMID: 34518051. Walton W, VonHagen S, Grigorian R, Zarbin M. Management of traumatic hyphema. Surv Ophthalmol. 2002;47:297–334. Fraser C, Liew S, Fitzsimmons R, Arnold J. Spontaneous resolution of corneal blood staining. Clin Exp Ophthalmol. 2006;34:279–80. Hui R, Rui J, Gezhi X, et al. Evaluation of endoscopy assisted vitrectomy for the treatment of severe traumatic eyes with no light perception. Chin J Ophthalmol. 2014;50(3):194–6. Yang X, Zhou Q, Du S. Conjunctival flap covering in the treatment of corneal blood staining. Can J Ophthalmol. 2011;46(5):442–3. Hammer ME, Grizzard WS. Endoscopy for evaluation and treatment of the ciliary body in hypotony. Retina. 2003;23:30–6. Yang X, et al. The Effect of Photocoagulation of Retinal Pigment Epithelium on the Intraocular Pressure of Hypotonic Rabbit Eyes Due to Retinal Defect. Ophthalmologica. 2014;232:80. Yao Mingjie D, Shu Z, Youyou X, Qiang W, Kun CAI, Wu, Yang Xun. &. (2025). Observation on the clinical effect of constant pressure oiling machine in the treatment of severe ocular trauma during vitrectomy. The ocular trauma professional eye diseases, 47 (1), 53 to 59. Holladay JT. Visual acuity measurements. J Cataract Refract Surg. 2004;30:287–90. Yan H, Cui J, Zhang J, Chen S, Xu Y. Penetrating keratoplasty combined with vitreoretinal surgery for severe ocular injury with blood-stained cornea and no light perception. Ophthalmologica. 2006;220(3):186-9. 10.1159/000091763 . PMID: 16679794. Zha Y, Du S, Wang S, Ren H, Yu J, Yang X. Value of Ocular Endoscopy in Extraction of Intraocular Foreign Bodies of Cilia in Patients with Open Ocular Trauma. Med Sci Monit. 2021;27:e932970. Yeo DCM, Nagiel A, Yang U, et al. Endoscopy for Pediatric Retinal Disease. Asia Pac J Ophthalmol (Phila). 2018;7:200–7. Kawashima S, Kawashima M, Tsubota K. Endoscopy-guided vitreoretinal surgery. Expert Rev Med Devices. 2014;11:163–8. Yu YZ, Zou YP, Zou XL. Endoscopy-assisted vitrectomy in the anterior vitreous. Int J Ophthalmol. 2018;11:506–11. Eckardt C, Paulo EB. Heads-up surgery for vitreoretinal procedures: An experimental and clinical study. Retina. 2016;36:137–47. Eckardt C, Paulo EB, HEADS-UP SURGERY FOR VITREORETINAL. PROCEDURES: An Experimental and Clinical Study. Retina. 2016;36:137–47. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8631674\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":592109909,\"identity\":\"1ef5d8cf-35e7-4032-ab86-bd0ce6d187c7\",\"order_by\":0,\"name\":\"Youyou Zha\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Soochow University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Youyou\",\"middleName\":\"\",\"lastName\":\"Zha\",\"suffix\":\"\"},{\"id\":592109910,\"identity\":\"0ba81be2-3a4e-4cf1-8e0f-8c6827e55b79\",\"order_by\":1,\"name\":\"Susie Du\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Soochow University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Susie\",\"middleName\":\"\",\"lastName\":\"Du\",\"suffix\":\"\"},{\"id\":592109914,\"identity\":\"5e3a6956-bf5f-4025-904f-7e9c6b125b7a\",\"order_by\":2,\"name\":\"Kun Wang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Soochow University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Kun\",\"middleName\":\"\",\"lastName\":\"Wang\",\"suffix\":\"\"},{\"id\":592109916,\"identity\":\"794ea5d3-c0eb-4f07-98b9-97e157b53fa5\",\"order_by\":3,\"name\":\"Haiya Fang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Soochow University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Haiya\",\"middleName\":\"\",\"lastName\":\"Fang\",\"suffix\":\"\"},{\"id\":592109918,\"identity\":\"5608b9de-9e6c-473b-85d1-80687df36e7c\",\"order_by\":4,\"name\":\"Jing Gong\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Soochow University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Jing\",\"middleName\":\"\",\"lastName\":\"Gong\",\"suffix\":\"\"},{\"id\":592109921,\"identity\":\"6b220831-9aa5-4a8a-88c0-42fd120c57a6\",\"order_by\":5,\"name\":\"Keju Chen\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Soochow University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Keju\",\"middleName\":\"\",\"lastName\":\"Chen\",\"suffix\":\"\"},{\"id\":592109925,\"identity\":\"84d5ce83-2ff1-4bf1-b51f-946f0f07dc7a\",\"order_by\":6,\"name\":\"Xun Yang\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArUlEQVRIiWNgGAWjYDCCA2DShoefv4E0LWkykjMOkKblsI1BQwKROvhunzGT5t1xnseA4QDjh485RGiRPJdjbMx75jaPOXMDs+TMbURoMTjDY/iYt+02j2XDATZmXiK1GBzmbTvHY3AggXgtIFsOkKBF8gxbseHctmQeyRkHm4nzC98Z5m0Sb9vs7Pn5mw9++EiMFgYGDgMog7GBKPVAwP6AWJWjYBSMglEwUgEA/nY0UxO/QokAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Soochow University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Xun\",\"middleName\":\"\",\"lastName\":\"Yang\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-01-18 13:53:20\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-8631674/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8631674/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":103883394,\"identity\":\"88d92c4e-cc96-477b-a258-75e83bacd351\",\"added_by\":\"auto\",\"created_at\":\"2026-03-04 06:11:16\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":540962,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8631674/v1/4445fca0-2efc-4aa3-9fae-68570dfcfb9c.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Endoscope-assisted vitrectomy for severe ocular trauma with corneal blood staining and no light perception: A clinical efficacy analysis\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eCorneal blood staining results from the deposition of hemoglobin and its breakdown products into the corneal stroma following hyphema\\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]\\u003c/sup\\u003e. Its reported incidence after traumatic hyphema ranges from 2% to 11%\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR4\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]\\u003c/sup\\u003e. The presence of corneal blood staining significantly obscures the surgical field, complicating conventional pars plana vitrectomy (PPV)\\u003csup\\u003e[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]\\u003c/sup\\u003e. Traditional management options for severe ocular trauma with NLP and corneal blood staining have often been limited to enucleation or combined procedures involving temporary keratoprosthesis, vitrectomy, and penetrating keratoplasty. These approaches are not only technically complex and costly but also dependent on donor cornea availability\\u003csup\\u003e[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]\\u003c/sup\\u003e. While mild corneal blood staining may resolve spontaneously and conjunctival flaps can provide symptomatic relief\\u003csup\\u003e[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]\\u003c/sup\\u003e, delaying vitrectomy until corneal clearing risks losing the optimal window for intraocular intervention, potentially leading to irreversible damage. Endoscope-assisted vitrectomy (EAV) offers a distinct advantage by enabling direct visualization of intraocular structures despite corneal opacity, allowing for precise removal of pathologic tissues, retinal reattachment, and minimizing the risk of iatrogenic injury to detached retina and choroid\\u003csup\\u003e[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]\\u003c/sup\\u003e. This study aimed to analyze the clinical features of severe ocular trauma with NLP complicated by corneal blood staining and to evaluate the efficacy and safety of EAV in this challenging patient population.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy Participants\\u003c/h2\\u003e \\u003cp\\u003eA retrospective review was performed on the clinical records of 23 patients (23 eyes) with severe ocular trauma, NLP, and corneal blood staining who underwent EAV by the same surgeon between June 2005 and October 2021 at Beijing Tongren Hospital, Chengdu Aier Eye Hospital, and Suzhou Lixiang Eye Hospital. All patients were male, with ages ranging from 10 to 57 years (mean, 36 years). The types of ocular injuries included globe rupture (17 eyes, 73.9%), penetrating injury (4 eyes), closed ocular blunt trauma (1 eye), and intraocular foreign body injury (1 eye).\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003ePreoperative Evaluation\\u003c/h3\\u003e\\n\\u003cp\\u003eAll affected eyes had NLP preoperatively. The preoperative IOP was below 10 mmHg in 12 eyes, below 6 mmHg in 8 eyes, and above 21 mmHg in 1 eye. Retinal detachment was present in 21 eyes, and choroidal detachment was noted in 14 eyes.\\u003c/p\\u003e\\n\\u003ch3\\u003eSurgical Technique\\u003c/h3\\u003e\\n\\u003cp\\u003eAll surgeries were performed under general anesthesia. The surgical approach was selected based on preoperative assessment: a corneal approach was used in 20 eyes, and a pars plana approach was employed in 3 eyes. When present, existing corneal lacerations were utilized as ports for the endoscope or instruments. Under direct endoscopic visualization, intraocular hemorrhage and vitreous were removed. The proliferative membranes were meticulously peeled off. Perfluorocarbon liquid was used to flatten and reattach the retina. If choroidal detachment persisted after the injection of perfluorocarbon liquid, a posterior sclerotomy was performed to drain the subretinal fluid. Retinal incisions were made for any identified retinal constrictions. All confirmed retinal breaks were treated with laser photocoagulation. Laser photocoagulation was also applied to the incised peripheral retina and the areas of exposed retinal pigment epithelium. During the operation, either gas tamponade or silicone oil tamponade was selected based on the retinal condition. If the initial volume of injected silicone oil was less than 4.5 mL, continuous silicone oil injection was performed to ensure adequate tamponade effect\\u003csup\\u003e[\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003ch3\\u003eFollow-up and Outcome Measures\\u003c/h3\\u003e\\n\\u003cp\\u003ePostoperative follow-up ranged from 0.1 to 45 months. Evaluations included assessments of visual acuity, IOP, and intraocular status. Visual acuity was converted to logMAR units for analysis: 3.2 for NLP, 2.9 for light perception (LP), 2.6 for hand motions (HM), and 2.3 for counting fingers (CF)\\u003csup\\u003e[\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical Analysis\\u003c/h2\\u003e \\u003cp\\u003eData analysis was performed using SAS software (version 9.4). Continuous variables are presented as mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;standard deviation or range, as appropriate. Comparisons between preoperative and postoperative parameters were made using paired t-tests. A P value of less than 0.05 was considered statistically significant.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eVisual Acuity Outcomes\\u003c/h2\\u003e \\u003cp\\u003ePostoperatively, visual acuity improved to LP or better in 13 eyes (56.5%). One eye achieved a best corrected visual acuity of 0.7. The improvement in visual acuity from preoperative levels was statistically significant (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eIntraocular Pressure Changes\\u003c/h3\\u003e\\n\\u003cp\\u003eThe mean postoperative IOP was 12.50 mmHg (range, 5 to 24 mmHg), which represented a significant increase from the preoperative mean of 9.9 mmHg (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). In the subgroup of eyes with a preoperative IOP below 6 mmHg, the mean postoperative IOP increased to 11.5 mmHg (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Transient postoperative IOP elevation to 24 mmHg occurred in one eye and was controlled with topical medication. One eye had a low postoperative IOP of 5 mmHg.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eRetinal Reattachment Status\\u003c/h2\\u003e \\u003cp\\u003eAnatomical reattachment of the retina was achieved in 10 of the 21 eyes (47.6%) with preoperative RD. For the remaining 11 cases, intraocular observation was not possible due to corneal opacity.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eComparison of Surgical Approaches\\u003c/h2\\u003e \\u003cp\\u003eNo statistically significant differences were observed between the corneal and pars plana approaches regarding the postoperative retinal reattachment rate (P\\u0026thinsp;=\\u0026thinsp;0.59), visual acuity recovery (P\\u0026thinsp;=\\u0026thinsp;0.89), or IOP changes (P\\u0026thinsp;=\\u0026thinsp;0.62).\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eCorneal Management and Outcomes\\u003c/h2\\u003e \\u003cp\\u003eA conjunctival flap was performed postoperatively in 3 eyes. The flaps were removed after a mean period of 15 months, resulting in corneal clearing. At the final follow-up examination, 5 eyes had clear corneas.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eComplications and Secondary Procedures\\u003c/h2\\u003e \\u003cp\\u003eSecondary silicone oil removal was performed in 2 eyes. During the follow-up period, silicone oil-related corneal leucomas were observed in 4 eyes. No instances of secondary glaucoma, iatrogenic retinal breaks, or intraocular hemorrhage were noted. Five eyes developed phthisis bulbi from persistent hypotony: 1 underwent enucleation, and 4 were followed up continuously.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eConventional pars plana vitrectomy (PPV) is significantly challenging in eyes with severe trauma presenting with NLP and corneal blood staining due to the obscured surgical view. In this context, endoscope-assisted vitrectomy (EAV) demonstrated several advantages in our case series based on its inherent technical features.\\u003c/p\\u003e \\u003cp\\u003eFirst, in traditional PPV, corneal pathology such as edema, laceration, scarring, and blood staining often necessitates the initial placement of a temporary keratoprosthesis, followed by combined corneal transplantation. This strategy is not only procedurally complex but also carries risks including graft rejection, astigmatism, and graft opacification (with reported rates of approximately 43% at one year and 57% beyond two years postoperatively)\\u003csup\\u003e[\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]\\u003c/sup\\u003e. In contrast, EAV allows direct visualization of intraocular structures independent of corneal clarity. This is particularly beneficial in cases complicated by conditions like endophthalmitis that require urgent intervention, where the cornea may regain transparency spontaneously after inflammation subsides, usually within about two weeks. EAV thus provides a feasible approach for its performance within an optimal surgical window.\\u003c/p\\u003e \\u003cp\\u003eIn our series, visual acuity recovered to better than LP in 56.5% of eyes postoperatively, suggesting that this technique can aid in visual pathway reconstruction under complex anatomical conditions.\\u003c/p\\u003e \\u003cp\\u003eSecond, severe ocular trauma is frequently associated with retinal or choroidal detachment. During conventional PPV, limited visualization increases the risk of iatrogenic damage to detached tissues and may even lead to infusion fluid or silicone oil entering the subchoroidal space. EAV, guided by the endoscope, provides clear delineation of anatomical planes. The corneal approach further allows surgeons to effectively circumvent anteriorly detached choroid, thereby reducing the risk of iatrogenic injury. Our results demonstrated anatomical reattachment in 47.6% (10/21) of eyes with preoperative retinal detachment (RD), with a significantly higher mean postoperative intraocular pressure (IOP) than preoperatively (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Intraoperative confirmation of retinal detachment was obtained in 21 cases, while retinal status could not be visualized due to corneal opacity in 11 of the cases. These findings indicate a positive role for EAV in restoring structural stability to the globe.\\u003c/p\\u003e \\u003cp\\u003eFurthermore, The nearly unlimited field of view provided by the endoscope facilitates the examination of the ora serrata and ciliary body region, which is advantageous for managing peripheral proliferative pathology and detecting occult foreign bodies\\u003csup\\u003e[\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]\\u003c/sup\\u003e. This capability is particularly important for addressing acute proliferative vitreoretinopathy (aPVR), a common sequela of trauma, and may contribute to reducing the incidence of postoperative complications such as hypotony. Phthisis bulbi occurred in 5 eyes (21.7% incidence) of this cohort. All 5 cases had severe intraoperative choroidal lacerations and a relatively long injury-to-treatment interval, both factors contributing to phthisis bulbi.\\u003c/p\\u003e \\u003cp\\u003eThe management of corneal blood staining involves balancing the timing and modality of intervention. In our cohort, three eyes that underwent postoperative conjunctival flap coverage eventually achieved corneal clarity, indicating that this method can be an effective adjunct for promoting blood stain resolution in selected patients. It is noteworthy that silicone oil tamponade was maintained long-term in most of our cases. Although corneal leucomas associated with silicone oil were observed in four eyes, no serious complications like secondary glaucoma occurred. This suggests that silicone oil filling retains clinical value in maintaining globe integrity and residual function in such complex injuries.\\u003c/p\\u003e \\u003cp\\u003eCertainly, endoscopic systems have inherent limitations\\u003csup\\u003e[\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]\\u003c/sup\\u003e, including the lack of stereoscopic vision, high demands on hand-eye coordination, and a associated learning curve\\u003csup\\u003e[\\u003cspan additionalcitationids=\\\"CR17\\\" citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]\\u003c/sup\\u003e. The absence of serious complications like iatrogenic retinal breaks in our series may be attributable to the surgeon's experience and meticulous technique. With the ongoing development of new technologies such as three-dimensional heads-up display systems\\u003csup\\u003e[\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]\\u003c/sup\\u003e, the precision and safety of endoscopic surgery are expected to improve further.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eLimitations\\u003c/h2\\u003e \\u003cp\\u003eThis study has several limitations, including its retrospective design, relatively small sample size, and heterogeneity in both injury patterns and follow-up durations. Future prospective studies with larger cohorts are warranted to further validate the efficacy and safety of EAV for managing this complex subset of ocular trauma.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eEndoscope-assisted vitrectomy appears to be a safe and effective surgical option for severe ocular trauma with NLP complicated by corneal blood staining. It promotes visual recovery, helps maintain IOP, and may reduce the risk of phthisis bulbi. The corneal approach is particularly suitable for cases with associated anterior choroidal detachment. Conjunctival flap coverage can serve as a useful adjunctive measure to facilitate corneal clearing in patients with blood staining.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e \\u003ch2\\u003eEthics approval and consent to participate\\u003c/h2\\u003e \\u003cp\\u003e This study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Ethics Review Committee of Lixiang Eye Hospital of Soochow University (Approval No: SLER2026150). The requirement for informed consent was waived by the committee due to the retrospective nature of the study and the use of fully anonymized data. All data were pseudonymized to protect patient privacy. As an observational study, it was exempt from clinical trial registration. No patients or the public were involved in the design, conduct, or reporting of this research. The datasets generated and analyzed are available from the corresponding author upon reasonable request.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e \\u003cp\\u003eNot applicable\\u003c/p\\u003e \\u003c/p\\u003e\\u003cp\\u003e \\u003ch2\\u003eCompeting interests\\u003c/h2\\u003e \\u003cp\\u003eThe authors declare no competing interests.\\u003c/p\\u003e \\u003c/p\\u003e\\u003ch2\\u003eFunding\\u003c/h2\\u003e \\u003cp\\u003eNone\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eThe authors\\u0026rsquo; responsibilities were as follows. Y.Z and S.D. collected the clinical data and performed the surgical procedures. K.W. and H.F. conducted the statistical analysis. J.G. assisted with data curation and literature review. Y.Z and K.C. drafted the initial manuscript. X.Y. conceived and designed the study, supervised the entire project, and critically revised the manuscript. All authors reviewed and approved the final version for publication.\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgements\\u003c/h2\\u003e \\u003cp\\u003eNone\\u003c/p\\u003e\\u003ch2\\u003eAvailability of data and materials\\u003c/h2\\u003e \\u003cp\\u003eThe datasets used and/or analyzed during the current study are available from\\u003c/p\\u003e \\u003cp\\u003ethe corresponding author on reasonable request.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eKiziltoprak H, Atesoglu Hİ, Tekin K, Yetkin E, Koc M. Evaluation of Densitometric Analysis for Early Detection of Corneal Blood Staining in Hyphema. Cornea. 2021;40(4):467\\u0026ndash;471. doi: 10.1097/ICO.0000000000002451. PMID: 32740008.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWoreta FA, Lindsley KB, Gharaibeh A, Ng SM, Scherer RW, Goldberg MF. Medical interventions for traumatic hyphema. Cochrane Database Syst Rev. 2023;3(3):CD005431. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1002/14651858.CD005431.pub5\\u003c/span\\u003e\\u003cspan address=\\\"10.1002/14651858.CD005431.pub5\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. PMID: 36912744; PMCID: PMC10010597.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLiebman DL, Aboobakar IF. Traumatic Hyphema: Diagnostic and Management Considerations. Int Ophthalmol Clin. 2024;64(2):49\\u0026ndash;61. doi: 10.1097/IIO.0000000000000490. Epub 2024 Mar 25. PMID: 38525981.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGenadry KC, Shrock C, O'Shea D, Vatsa R, Shah AS, Gise R, Lipsett SC. Traumatic Hyphema. J Emerg Med. 2021;61(6):740\\u0026ndash;741. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.jemermed.2021.07.041\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.jemermed.2021.07.041\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. Epub 2021 Sep 11. PMID: 34518051.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWalton W, VonHagen S, Grigorian R, Zarbin M. Management of traumatic hyphema. Surv Ophthalmol. 2002;47:297\\u0026ndash;334.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFraser C, Liew S, Fitzsimmons R, Arnold J. Spontaneous resolution of corneal blood staining. Clin Exp Ophthalmol. 2006;34:279\\u0026ndash;80.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHui R, Rui J, Gezhi X, et al. Evaluation of endoscopy assisted vitrectomy for the treatment of severe traumatic eyes with no light perception. Chin J Ophthalmol. 2014;50(3):194\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYang X, Zhou Q, Du S. Conjunctival flap covering in the treatment of corneal blood staining. Can J Ophthalmol. 2011;46(5):442\\u0026ndash;3.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHammer ME, Grizzard WS. Endoscopy for evaluation and treatment of the ciliary body in hypotony. Retina. 2003;23:30\\u0026ndash;6.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYang X, et al. The Effect of Photocoagulation of Retinal Pigment Epithelium on the Intraocular Pressure of Hypotonic Rabbit Eyes Due to Retinal Defect. Ophthalmologica. 2014;232:80.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYao Mingjie D, Shu Z, Youyou X, Qiang W, Kun CAI, Wu, Yang Xun. \\u0026amp;. (2025). Observation on the clinical effect of constant pressure oiling machine in the treatment of severe ocular trauma during vitrectomy. The ocular trauma professional eye diseases, 47 (1), 53 to 59.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHolladay JT. Visual acuity measurements. J Cataract Refract Surg. 2004;30:287\\u0026ndash;90.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYan H, Cui J, Zhang J, Chen S, Xu Y. Penetrating keratoplasty combined with vitreoretinal surgery for severe ocular injury with blood-stained cornea and no light perception. Ophthalmologica. 2006;220(3):186-9. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1159/000091763\\u003c/span\\u003e\\u003cspan address=\\\"10.1159/000091763\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. PMID: 16679794.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eZha Y, Du S, Wang S, Ren H, Yu J, Yang X. Value of Ocular Endoscopy in Extraction of Intraocular Foreign Bodies of Cilia in Patients with Open Ocular Trauma. Med Sci Monit. 2021;27:e932970.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYeo DCM, Nagiel A, Yang U, et al. Endoscopy for Pediatric Retinal Disease. Asia Pac J Ophthalmol (Phila). 2018;7:200\\u0026ndash;7.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKawashima S, Kawashima M, Tsubota K. Endoscopy-guided vitreoretinal surgery. Expert Rev Med Devices. 2014;11:163\\u0026ndash;8.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eYu YZ, Zou YP, Zou XL. Endoscopy-assisted vitrectomy in the anterior vitreous. Int J Ophthalmol. 2018;11:506\\u0026ndash;11.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eEckardt C, Paulo EB. Heads-up surgery for vitreoretinal procedures: An experimental and clinical study. Retina. 2016;36:137\\u0026ndash;47.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eEckardt C, Paulo EB, HEADS-UP SURGERY FOR VITREORETINAL. PROCEDURES: An Experimental and Clinical Study. Retina. 2016;36:137\\u0026ndash;47.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Endoscope-assisted vitrectomy, Severe ocular trauma, Corneal blood staining, Retinal detachment, No light perception\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8631674/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8631674/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eObjective\\u003c/h2\\u003e \\u003cp\\u003eTo evaluate the clinical characteristics and therapeutic efficacy of endoscope-assisted vitrectomy (EAV) for severe ocular trauma complicated by corneal blood staining and no light perception (NLP).\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eA retrospective study was conducted on 23 eyes of 23 patients with severe ocular trauma, corneal blood staining, and NLP who underwent EAV. Among them, 21 eyes were complicated by retinal detachment (RD), and 2 eyes had corneal laceration. The mean interval from injury to surgery was 20.43 days (range, 5 to 64 days). Preoperatively, all eyes had NLP with a mean intraocular pressure (IOP) of 9.9 mmHg (range, 2 to 37.4 mmHg). The mean follow-up period was 8.62 months (range, 0.1 to 45 months).\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003ePostoperative visual acuity was significantly improved compared with preoperative levels (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05). Visual acuity recovered to light perception or better in 13 eyes (56.5%), with the best corrected visual acuity reaching 0.7 in one eye. Anatomical retinal reattachment was achieved in 10 of the 21 eyes (47.6%) with preoperative RD. The mean postoperative IOP was 12.50 mmHg (range, 5 to 24 mmHg), which was significantly higher than the preoperative mean (P\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05).\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003eEndoscope-assisted vitrectomy is a safe and effective technique for managing severe ocular trauma with corneal blood staining and NLP. It facilitates visual function recovery and may help reduce the risk of phthisis bulbi.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Endoscope-assisted vitrectomy for severe ocular trauma with corneal blood staining and no light perception: A clinical efficacy analysis\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-02-17 12:52:20\",\"doi\":\"10.21203/rs.3.rs-8631674/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"b3256e66-5184-4e16-b229-f2ed153b6c01\",\"owner\":[],\"postedDate\":\"February 17th, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-03-04T06:10:32+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-02-17 12:52:20\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8631674\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8631674\",\"identity\":\"rs-8631674\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}