۱۴۰۲-۰۶-۱۰ | Farabi Retina

Key Points Question

Is in-office suprachoroidal viscopexy feasible for the treatment of rhegmatogenous retinal detachment (RRD)?

Findings : In this single-case report, the injection of suprachoroidal sodium hyaluronate, 1%, in the region of the break in a fovea-off RRD led to macular reattachment in less than 24 hours with excellent microstructural recovery. Laser retinopexy was performed, and the patient was able to resume normal activity immediately with no restrictions.

Meaning : In-office suprachoroidal viscopexy is a minimally invasive technique for RRD repair that requires no incisions, no tamponade agent, and no positioning.

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.

The article discusses the use of a new technique called swab pressing to seal incisions in phacoemulsification for age-related cataract, as compared to the current practice of stromal hydration.

The study conducted a randomized controlled clinical trial with 126 participants to determine the efficacy of swab pressing. The main outcome measured was the proportion of closed clear corneal incisions evaluated using intraoperative optical coherence tomography.

In the pressing group, a cotton swab was used to applygentle pressure on the incision downward for 30 seconds im-mediately after the withdrawal of irrigation and aspiration (I/A)handpiece tip. In the stromal hydration group, a balanced saltsolution was injected toward the anterolateral walls of the in-cision until visible whitening of the corneal stroma was noted.

The results showed that swab pressing was noninferior to stromal hydration in sealing the incisions, with a proportion of closed incisions of 96.8% in the swab pressing group and 93.7% in the stromal hydration group. The rate of anterior chamber collapse was also lower in the swab pressing group.

The study suggests that swab pressing is a feasible technique, but further investigations are needed to determine its effects on the collapse of the anterior chamber and visual acuity outcomes.

Liu, Zitian, et al. “Swab Pressing vs Stromal Hydration to Prevent Incision Leakage and Transient Collapse of Anterior Chamber in Phacoemulsification: A Randomized Clinical Trial.” JAMA Ophthalmology, vol. 141, no. 6, 1 June 2023, pp. 574-81, doi:10.1001/jamaophthalmol.2023.1491.

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