Suprachoroidal Buckling for Retinal Detachment

Abstract

T he use of scleral buckles in conjunction with chorioretinal adhesions around the break forms the basis of therapy for many uncomplicated rhegmatogenous retinal detachment (RD). Other techniques for repair include vitrectomy and a gas tamponade or repair by pneumatic retinopexy. Rhegmatogenous RD is repaired by preventing access of intravitreal fluid to the subretinal space via retinal breaks. 1 Fulfilling this base scleral buckling brings retina into contact with treated choroid around retinal tears. 2 This is done by indenting both the sclera and the choroid to the retina, with some potentials of mechanical ocular motility disturbance depending on the size and location of the buckle placement. Based on indenting the choroid alone to close the retinal tear through the suprachoroidal space, we show a novel technique using a special designed catheter to inject and place a suprachoroid filler (long-lasting hyaluronic acid [HA]) in the suprachoroidal space. This filler indent the choroid and creates a suprachoroidal buckling effect to close the tears or support the retina. This is done by a small 3-mm incision and guide the catheter to the tear avoiding all potential difficulties of placing scleral buckles (Video, Supplemental Digital Content; http://links.lww.com/IAE/A144).

Thickness and Closure Kinetics of the Suprachoroidal Space Following Microneedle Injection of Liquid Formulations

“…In another application, SCS injections of sodium hyaluronate have been made as an alternative to scleral buckling for the treatment of retinal detachment. 44 , 45 As shown in the present study, greater distension and localization are achievable with CMC, which continues to expand after injection, compared with hyaluronic acid (i.e., a major component of Discovisc), which does not. Perhaps use of CMC as a liquid formulation may yield better results.…”

Ageing of the vitreous: From acute onset floaters and flashes to retinal detachment

“…The most common reason for failure of this surgical technique is development of PVR (Asaria and Gregor, 2002). More recently, an alternative to the external buckling has been developed -internal buckling involving injection of modified HA material supra-choroidally, thus tamponading against the retinal tear from the inside of the eye and centripetally (El Rayes and Oshima, 2013). The benefits and side-effects of this procedure remain to be reported and peer reviewed in the near future.…”

Advances in Vitreoretinal Surgery

“…In this method, a lighted catheter is inserted into the suprachoroidal space and placed to any desired area over the breaks; there, an enduring hyaluronic acid filler can be injected to create choroidal indentation. This can be performed with or without pars plana vitrectomy and has been reported effective for the treatment of patients with retinal detachment [49,50].…”