Hemorrhagic complications associated with suprachoroidal buckling

Abstract

Background: Multiple surgical techniques exist for the repair of rhegmatogenous retinal detachments (RRD). Suprachoroidal buckling (SCB), consisting of injecting viscoelastic material in the suprachoroidal space to allow chorioretinal apposition, has been recently described in the repair of RRD. The aim of this study is to report the complications of SCB and to propose measures to decrease their incidence during the learning curve. Methods:A total of 26 eyes of 26 patients who underwent a SCB procedure for the management of RRD secondary to a single or multiple retinal breaks were enrolled. Patients were operated between January 2014 and March 2017 at two academic institutions. Patient and retinal detachment characteristics were obtained from the charts. Surgical videos were reviewed for every case and intraoperative complications were recorded. Complications observed postoperatively were obtained from the charts.Results: Sixteen eyes (62%) underwent SCB alone, 5 eyes (19%) underwent additional gas tamponade and 5 eyes (19%) had combined pars plana vitrectomy. The most common complication was hemorrhage (6 cases, 23%). There were no cases of ischemic choroidal changes or hyperpigmentation at the edge of the dome. All six complications occurred in phakic patients who had inferior RRD with retinal breaks in the inferior quadrants. Isolated subretinal hemorrhage occurred in 4 patients and isolated suprachoroidal hemorrhage in 1 patient, and those did not affect final visual outcome. Extensive combined subretinal and suprachoroidal hemorrhage occurred in one case, and was complicated by phthisis bulbi. Re-detachment occurred in 4/6 (67%) of patients, and 5/6 (83%) of patients required a secondary procedure. Three out of 6 patients (50%) had at least 2 lines of visual acuity improvement.Conclusion: SCB performed for RRD can be associated with hemorrhagic complications. The hemorrhages are usually self-limited but may occasionally result in severe visual compromise when involving the suprachoroidal space. Specific surgical measures need to be undertaken in order to decrease the likelihood of complications and further studies are needed to assess the safety and efficacy of this technique.

Vortex Vein Imaging: What Can It Tell Us?

“… 82 , 83 A possible complication resulting from direct damage to the vortex vein during this procedure is suprachoroidal hemorrhage, which is thought to result from injury to this highly vascular region of the choroid. 84 Furthermore, a recent report has associated a vortex vein varix with recurrent suprachoroidal hemorrhage which occurred in close proximity to the varix. 85 A better understanding of vortex vein anatomy and its variations in healthy and diseased states may curb the unnecessary investigations by retinal surgeons dealing with such eyes.…”

Modification of the Suprachoroidal Buckling Technique for the Treatment of Rhegmatogenous Retinal Detachment

“…Mikhail et al 4 reported suprachoroidal hemorrhage because of catheter misplacement in a phakic patient with inferior retinal break. Moreover, Antaki et al 5 studied frequency and type of hemorrhagic complications associated with SCB with respect to the surgical step. The incidence of hemorrhagic complications was 23% (6/26).…”

“…8 It is often described as having a steep learning curve. [3][4][5] Undoubtedly, surgeon-related factors, complexity of the surgical technique, and patient selection may significantly affect efficacy, safety, and final outcomes. 9 Individualized approach is recommended for the treatment of primary RRD.…”

“…Furthermore, the original SCB technique was previously modified using a curved illuminated endolaser probe instead of a chandelier. 5 That allows for focal bright peripheral illumination of the advancing cannula and the target area during SCI compared with stationary and diffuse form of illumination provided by chandelier. Injecting the ProVisc under foot-pedal control frees one surgeon's hand for endoilluminator probe without affecting adequate cannula position and stability in the suprachoroidal space.…”

“…3,4 However, a combined subretinal and suprachoroidal hemorrhage complicated by phthisis bulbi was reported during SCB in a patient who discontinued acetylsalicylic acid for 2 days before surgery. 5 Hence, a more precise SCB technique, along with careful patient selection, may enhance the safety profile.…”