There’s a new procedure in the rhegmatogenous retinal detachment (RRD) world—and it may not require an OR.
In-office retinal detachment surgery could be coming soon to a clinic near you. According a recent case series published in JAMA Ophthalmology, suprachoroidal viscopexy (SCVEXY), a minimally invasive, office-based technique, may offer an alternative to traditional surgery for certain cases of rhegmatogenous retinal detachment (RRD).
This novel procedure, performed in an office setting, involves injecting a viscoelastic material into the suprachoroidal space using a custom-made guarded needle. The injection creates a dome-shaped buckle under the retina, closing the tear and allowing it to naturally reattach as the subretinal fluid is absorbed by the retinal pigment epithelium pump. A laser is then used around the retinal break, creating chorioretinal adhesion, and the viscoelastic is gradually absorbed.
Source: JAMA Ophthalmology
A small study conducted at St. Michael’s Hospital in Toronto, Canada, explored the potential of SCVEXY. Six patients with acute retinal detachments underwent the procedure, and all had retinal tears located in areas accessible for this technique.
Five of the six patients (83.3%) achieved successful retinal reattachment without needing additional procedures. For these patients, vision improved significantly, with preoperative levels ranging from hand motions to 20/100 and postoperative levels reaching between 20/20 and 20/50.1
Source: JAMA Ophthalmology
One patient experienced initial failure due to improper placement of the viscoelastic, but a follow-up procedure successfully reattached the retina, improving their vision to 20/70.
Follow-up imaging showed that the viscoelastic material remained in the suprachoroidal space for about 16 days on average. Importantly, no complications like retinal folds or displacement occurred, and all patients resumed normal activities immediately following the procedure.1
While the study highlighted SCVEXY’s potential, it also noted some risks. A patient developed a small choroidal effusion unrelated to the injection, which resolved with topical treatment within a week. Temporary issues with blood flow in the central retinal artery occurred in two cases but were resolved immediately. Additionally, two patients experienced minor viscoelastic leakage under the conjunctiva, which cleared up without further problems.1
In a commentary on the study, Heng et al. emphasized that SCVEXY is not suitable for every case of retinal detachment. It works best for patients with a single tear or tears located within one clock hour of each other, and the technique requires initial success in reattaching the retina to proceed with the laser treatment. Given these constraints, SCVEXY is likely to be applicable only to a limited subset of retinal detachments.2
Heng et al. suggested refining the procedure by combining it with other techniques, such as external subretinal fluid drainage or intravitreal air/gas injection. They also recommended personalizing viscoelastic volumes and exploring viscoelastics with different half-lives or expansile properties, as well as standardizing the tools to improve outcomes and broaden the technique’s applicability.2
Despite these challenges, SCVEXY offers several advantages over traditional surgical methods. It eliminates the need for anesthesia or operating room and does not impose strict postoperative positioning or activity restrictions on patients. However, the findings are based on a small sample size, and more extensive research is necessary to validate its safety and effectiveness.
This innovative procedure holds promise as a faster, less invasive option for treating retinal detachments. As research progresses, SCVEXY could become a valuable addition to the array of treatments available.
References
- Muni RH, Melo IM, Demian S, Minelli T, Batawi H, Park J, Pecaku A. In-Office Suprachoroidal Viscopexy for Acute Rhegmatogenous Retinal Detachment. JAMA Ophthalmol. 2024 Dec 12 [Epub ahead of print].
- Heng JS, Paulus YM. Invited commentary: Novel in-office procedure for retinal detachment. JAMA Ophthalmol. Published online December 12, 2024. Available at: https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2827722?. Accessed on December 13, 2024.
