Abstract
BackgroundMultiple 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.MethodsA 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.ResultsSixteen 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.ConclusionSCB 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.
Highlights
Rhegmatogenous retinal detachment (RRD) is the most common form of retinal detachment (RD) and is associated with a high risk of visual impairment and complications if left untreated [1]
In this study, we report the complication rate associated with suprachoroidal buckling technique (23%)
We described all six hemorrhagic complications and attempted to identify patient risk factors and intraoperative parameters that might have contributed to those complications
Summary
Rhegmatogenous retinal detachment (RRD) is the most common form of retinal detachment (RD) and is associated with a high risk of visual impairment and complications if left untreated [1]. In 1983, Poole et al described the use of the space between the choroid and the sclera, the suprachoroidal space rather than the episcleral space for buckling in the treatment of retinal detachment. This approach could mitigate the risks described above [7]. The opportunity of using this space has been revisited with a novel technique described for suprachoroidal buckling (SCB), consisting of injecting viscoelastic material (e.g. sodium hyaluronate) in the suprachoroidal space, thereby temporarily indenting the choroid at the desired location where peripheral breaks are present to allow chorioretinal apposition and retinal reattachment [8, 9]. The aim of this study is to report the complications of SCB and to propose measures to decrease their incidence during the learning curve
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