New research published in JAMA Ophthalmology explored the use of an in-office suprachoroidal viscopexy for the treatment of rhegmatogenous retinal detachment (RDD) in a single-case report.
Give me some background first.
After replacing scleral buckle (SB) as the treatment of choice for RDD, pars plana vitrectomy (PPV) has dominated the surgical landscape. In recent years, however, multimodal imaging data has revealed a high risk of unwanted structural abnormalities associated with post-PPV.
Further, other procedures to correct these (subretinal fluid drainage, heavy liquids, large gas tamponades) have proven to be potentially harmful.
Thus, surgeons have sought to “modify techniques to not only achieve single-operation reattachment, but also maximize the integrity of reattachment.”
What did they come up with?
Investigators developed suprachoroidal viscopexy (SCVEXY), a minimally-invasive, in-office treatment option to repair RDD without the need for an incision, intravitreal tamponade, or patient positioning.
The technique includes:
- A complete natural reabsorption of the viscoelastic agent
- Reduced invasiveness
- Immunologically inert substances
So there’s no risk associated with this?
Not quite. Compared to other suprachoroidal space (SCS) approaches, SCVEXY is a less invasive form of SCS viscoelastic injections.
However, potential risk factors include choroidal hemorrhage, infection, and inadvertent intraocular injection or retinal perforation.
Gotcha. Now talk about this patient case.
A male patient (age: mid-50s) presented with pseudophakia and recent vision loss.
He had a best-corrected visual acuity (BCVA) of 20/50 OD and a fovea-off RRD extending from 6 to 10 o’clock with no definitive causative retinal break.
And the procedure?
A SCVEXY injection of 0.4 mL viscoelastic—sodium hyaluronate, 1% (Provisc, Alcon)—was administered into the SCS within the eye, creating an indentation at the retinal tear location to close it.
The procedure was conducted using a 30-gauge needle with a custom-made guard that exposed 1 mm of the needle.
Now the results.
According to the researchers, the patient achieved macular reattachment less than 24 hours after the procedure, and was able to resume normal activity with no restrictions.
Longitudinal swept-source optical coherence tomography (SS-OCT) revealed rapid recovery of the outer retinal bands; additional OCT imaging of the choroidal convexity space demonstrated the viscoelastic material location within the SCS.
What else?
No retinal displacement was observed via fundus autofluorescence (FAF) imaging.
Further, “laser retinopexy was applied in the suspected region of the tear on the first postoperative day,” the study authors wrote.
Any abnormalities?
Nope! That goes for outer retinal folds, residual subfoveal fluid, and retinal displacement.
What about beyond the first postop day?
By postop Day 5, the patient’s BCVA was 20/25; it remained stable through the first month of follow-up.
The researchers also reported that the choroidal convexity reduced in size during the first week of postop; by two weeks, it had completely resolved.
Limitations?
The authors noted that, as this was a single-case report with a short follow-up, the results are limited in determining the following:
- SCVEXY benefits
- Potential adverse events
- Failure rates
- Best-case selection
They recommend further research to better refine both the procedure and to assess its efficacy and safety.
Did the results leave any questions unanswered?
Indeed it did.
Given their limited experience, the authors identified three areas where they are still uncertain when it comes to SCVEXY:
- Potential concerns on intraocular pressure (IOP) increases with large volumes of viscoelastic injection
- Difficulty controlling exact direction of viscoelastic expansion
- Variations in choroidal elevation subsidence time course
So what was their conclusion?
The authors concluded that, when successful, SCVEXY has the potential to “maximize anatomical outcomes of integrity and functional outcomes” for select RDD patients.
They also stressed that their early experience and limited follow-up may hinder their ability to accurately determine the procedure’s benefits, potential AEs, failure rates, and ideal case selection.”