In-Office Suprachoroidal Viscopexy for Rhegmatogenous Retinal Detachment Repair

Abstract

Importance: In-office suprachoroidal viscopexy (SCVEXY) is a minimally invasive technique for rhegmatogenous retinal detachment (RRD) repair that can be performed with no incision, no tamponade agent, and no positioning requirements. This technique has the potential to be a step forward in the armamentarium to treat RRDs.

Objective: To describe in-office SCVEXY for RRD repair.

Design, setting, and participant: In this single-case report with short follow-up, a man in his 50s with pseudophakia and recent visual loss presented to St Michael's Hospital, Unity Health Toronto, with a fovea-off RRD in the right eye, extending from 6 to 10 o'clock, with no visible causative retinal break.

Exposure: Injection of suprachoroidal sodium hyaluronate, 1%, in the region of the suspected break, using a 30-gauge needle with a custom-made guard that exposed only 1 mm of the needle.

Main outcome and measures: Ability to perform in-office SCVEXY and to obtain a visible choroidal indentation.

Results: After the procedure, a dome-shaped choroidal convexity was present in the superior temporal area. The patient achieved macular reattachment in less than 24 hours with no postoperative abnormalities, such as outer retinal folds, residual subfoveal fluid, or retinal displacement, with rapid recovery of the outer retinal bands on optical coherence tomography. The optical coherence tomography scans acquired in the area of the choroidal convexity demonstrated the location of the viscoelastic material in the suprachoroidal space. Laser retinopexy was applied in the suspected region of the retinal tear, and the patient was able to resume normal activity immediately after the procedure with no restrictions.

Conclusions and relevance: Suprachoroidal viscopexy is feasible as an in-office technique to create a temporary choroidal buckle for RRD repair. It is a minimally invasive procedure with the potential to maximize anatomical outcomes of integrity and postoperative functional outcomes in RRD because its mechanism of action does not require drainage of subretinal fluid or intraocular gas tamponade. Nevertheless, this was a single-case report with short follow-up, which limits the ability to determine the procedure's benefits, potential adverse events, failure rates, and best-case selection. Further work is required to refine the procedure and assess its efficacy and safety.

Figure 1.. Longitudinal Progression of the Retinal Detachment on Ultrawide-Field Photographs

Longitudinal ultrawide-field photographs of a man in his 50s with pseudophakia presenting with a rhegmatogenous retinal detachment (RRD) in the right eye. A, Baseline image demonstrating a fovea-involving inferotemporal RRD from 6 to 10 o’clock, with no definitive causative retinal break. B, First-day post–suprachoroidal viscopexy (SCVEXY) demonstrating substantial resolution of the retinal detachment with some initial spots of laser retinopexy that were applied to the temporal periphery. A small localized temporal hemorrhage was noted near the injection site. C, Third-day post-SCVEXY demonstrating complete laser retinopexy barricade in the suspected region of the causative retinal break.

Figure 2.. Choroidal Indentation After Intraoperative Suprachoroidal Viscopexy (SCVEXY)

Final appearance of the choroidal convexity formed after SCVEXY.

Figure 3.. Longitudinal Reabsorption of the Suprachoroidal Viscoelastic

Longitudinal vertical swept-source optical coherence tomography was performed at the viscopexy injection site, demonstrating the progressive reabsorption of the suprachoroidal viscoelastic (hyporeflective space between the choroid and sclera indicated by the arrowheads) from postoperative day 1 (A) to postoperative day 5 (B).