Key Points
Question
What are the outcomes following in-office suprachoroidal viscopexy (SCVEXY) for primary acute rhegmatogenous retinal detachment (RRD)?
Findings
In this case series, 5 of 6 patients (83.3%) achieved reattachment without additional procedures, retinal displacement, or outer retinal folds. Preoperative visual acuities ranged from 20/100 to hand motions and postoperatively ranged from 20/20 to 20/50 in 5 patients and to 20/70 in the sixth case that underwent rescue pneumatic retinopexy.
Meaning
In-office SCVEXY is a novel technique for RRD that does not require incisional surgery, intraocular tamponade, positioning, or restrictions; these cases suggest a potential role for SCVEXY, although randomized comparisons with standard of care and larger sample sizes for safety are required.
Abstract
Importance
In-office suprachoroidal viscopexy (SCVEXY) is a relatively new procedure for rhegmatogenous retinal detachment (RRD), but minimal information is available regarding outcomes and safety.
Objective
To report outcomes with in-office SCVEXY for primary acute RRD.
Design, Setting, and Participants
This retrospective case series was conducted at St Michael’s Hospital in Toronto, Ontario, Canada from June 2023 to February 2024 among consecutive patients with primary acute RRDs who presented with retinal tears that were reachable with the current in-office SCVEXY technique in the temporal or nasal retina.
Exposure
Suprachoroidal injection of 0.6 mL of sodium hyaluronate, 2.3%, at the break location using a 30-gauge needle with a custom-made guard leaving 1 mm of the needle exposed. Laser retinopexy was applied around the break once reattachment was achieved.
Main Outcome and Measures
The primary outcome was primary anatomic reattachment rate with SCVEXY and recovery of function and anatomic integrity.
Results
Among 6 patients, 2 patients (33.3%) were female, and mean (SD) patient age was 52.5 (19.7) years. The final follow-up duration for each patient was 510, 420, 360, 360, 330, and 320 days, respectively. Baseline VAs were hand motions, counting fingers, 20/100, 20/100, 20/25, and hand motions for patients 1 through 6, respectively. A dome-shaped suprachoroidal buckle was present in all cases after the procedure. Five of 6 patients (83.3%) achieved anatomic reattachment with no retinal displacement or outer retinal folds, and these patients could resume normal activity immediately after the procedure with no restrictions. The mean (SD) logMAR VA at 3 months was +0.46 (0.34) (Snellen 20/57). The viscoelastic persisted in the suprachoroidal space as confirmed by multimodal imaging for 10, 14, 21, 13, 24, and 14 days, respectively, and the retina remained attached during the entire postoperative follow-up period. One patient’s SCVEXY failed due to inadequate viscoelastic at the posterior edge of the retinal break, and this patient underwent a successful pneumatic retinopexy. One patient developed a localized choroidal effusion unrelated to the SCVEXY site following laser retinopexy that resolved in 1 week associated with topical prednisolone, 1%, 4 times daily and cyclopentolate, 1%, twice daily.
Conclusions and Relevance
In this case series, the outcomes of these 6 cases suggest that SCVEXY may offer durable retinal reattachment in RRD. However, randomized clinical trial data, larger sample sizes, and longer-term follow-up are necessary to assess the risk-benefit profile of SCVEXY compared with the standard of care.
This case series study of 6 patients treated at a single center in Canada reports outcomes with in-office suprachoroidal viscopexy for primary acute rhegmatogenous retinal detachment.
Introduction
Primary anatomic reattachment of the retina with a single operation has historically been considered the most important outcome among vitreoretinal surgeons. However, understanding the microstructural biomechanics of retinal reattachment and how various surgical maneuvers impact the integrity of reattachment has consistently highlighted a central theme in recent research, which is that natural reabsorption of subretinal fluid (SRF) by the retinal pigment epithelium (RPE) without forced drainage and large gas tamponades leads to better anatomic and functional outcomes.1,2,3,4,5,6,7,8 Pneumatic retinopexy (PnR), which follows these principles, has certain limitations related to the need for strict patient positioning and restriction from work and leisure activity, as well as the fact that rhegmatogenous retinal detachments (RRDs) with inferior breaks are difficult to treat with PnR. Our experience with in-office procedures for RRD, the desire to maximize anatomic outcomes of integrity and functional outcomes, such as visual acuity (VA), metamorphopsia, and aniseikonia, and the more recent desire to avoid a tamponade agent and positioning altogether, without the need for incisional surgery, led to the concept of in-office suprachoroidal viscopexy (SCVEXY), which was first published in August 2023.9 However, this was only 1 case report with a short follow-up duration of 5 days. Apart from that singular case report, this retrospective case series summarizes 6 additional patients who underwent in-office SCVEXY, with follow-up duration ranging from 320 to 510 days.
Methods
In this single-surgeon (R.H.M.) retrospective case series, 6 consecutive patients with acute RRD were treated at St Michael’s Hospital, Unity Health Toronto, in Toronto, Ontario, Canada between June 2023 and February 2024. These patients presented with retinal tears that were reachable with the current SCVEXY technique (using a straight needle) in the temporal or nasal retina where adequate exposure could be achieved to inject the viscoelastic in the suprachoroidal space (SCS). Patients were required to have a single break or multiple breaks close together (located within 1 clock hour) between the 8- and 10-o’clock positions or between the 2- and 4-o’clock positions along the interpalpebral fissure. Patients with retinal breaks outside these areas or with poor visualization were excluded. As this represents a new technique, the procedure was offered to patients who were also eligible for PnR in accordance with clinical trial criteria (PIVOT).10 Additionally, patients with lattice degeneration or other peripheral retinal pathology could be included. Patients were thoroughly informed that SCVEXY is a novel technique, with the first case reported in August 2023, and that its efficacy and safety are unknown. Those who were willing to provide written informed consent for the new procedure with an uncertain risk-benefit profile underwent the procedure. In addition, to be eligible for the SCVEXY procedure, patients had to have a dysregulated RRD, defined as an acute, extensive, and progressive RRD.11,12,13
Ethics approval was obtained from the research ethics board at St Michael’s Hospital, Unity Health Toronto, and the study was performed according to principles outlined in the Declaration of Helsinki. Consent was obtained to publish patient images and videos, and measures were taken to protect patient privacy. Finally, the guidelines for case series by Kempen14 were followed.
Procedure
In-office SCVEXY was conducted under subconjunctival anesthesia, with the same procedure outlined by Muni and colleagues in 2023 (Video 1).9 This involved using 0.6 mL of sodium hyaluronate, 2.3% (Healon5 Pro; Johnson & Johnson Vision), administered into the SCS with a 30-gauge guarded needle that exposed 1 mm of the needle. The custom guard was made using intravenous tubing (Canadian Hospital Specialties MED-RX, lot 165225). The sodium hyaluronate, 2.3%, was injected after the needle was placed at the location of the break, with its position and indentation visualized using the indirect ophthalmoscope. Once the optimal placement was confirmed, the assistant proceeded with the injection as directed by the surgeon. Central retinal artery (CRA) perfusion was then assessed. If the CRA was nonperfused, an anterior chamber (AC) paracentesis was performed. Laser retinopexy with indirect ophthalmoscopy was applied around the break once reattachment was achieved. Patients were encouraged to resume normal activity immediately following the procedure, with no restrictions. Patients were seen daily until retinopexy was completed, followed by visits at 1, 2, and 4 weeks and at 3, 6, and 12 months.
Video 1. Animated Illustration of the Suprachoroidal Viscopexy Procedure.
Image Analysis
All patients underwent imaging with ZEISS PLEX Elite 9000 Swept Source OCT (Carl Zeiss) using high-definition horizontal 1-line spotlight 16-mm scans (n = 100), high-definition horizontal 51-line 12-mm scans, and Optos Silverstone ultra-widefield–guided swept-source optical coherence tomography (SS-OCT) at presentation and at each follow-up assessment. Imaging of the detached retina was performed with the tracker off to capture a foveal scan. Baseline morphologic changes in the outer retina were evaluated per the staging system published by our group.15 OCT scans were examined to detect residual subfoveal fluid (SFF) and outer retinal folds at 3 months and final follow-up. Ultra-widefield fundus autofluorescence imaging (Optos) was assessed for the presence of retinal vessel printings (RVPs), a biomarker of retinal displacement. Suprachoroidal viscoelastic was evaluated at each visit until the last discernible trace within the SCS was detectable with SS-OCT.
The primary outcome was the primary anatomic reattachment rate with SCVEXY. Secondary outcomes included Snellen VA reported at postoperative month 3 and final follow-up, in addition to multimodal imaging outcomes. Furthermore, any adverse events were also documented and reported. Descriptive statistics used for normally distributed data were means with standard deviation and medians with interquartile ranges were used for non-normally distributed data. All analyses were performed using SPSS version 28 (IBM).
Results
A total of 6 patients were included in this case series. Two patients (33.3%) were female, and mean (SD) patient age was 52.5 (19.7) years. The mean (SD) postoperative follow-up period was 383.3 (71.1) days. The final follow-up durations for each patient were 510, 420, 360, 360, 330, and 320 days, respectively. The mean (SD) baseline logMAR VA was +1.5 (1.2) (Snellen 20/632), with VAs for each case as follows: hand motions (HM), counting fingers (CF), 20/100, 20/100, 20/25, and HM, respectively. All patients had phakic lens status at baseline and 1 patient had intracameral contact lenses for pathologic myopia. The mean (SD) duration of symptoms was 9.8 (7.6) days. Five patients (83.3%) were fovea off, with a mean (SD) RRD extent of 4.2 (0.8) clock hours.
A dome-shaped suprachoroidal buckle was achieved in all cases. Five patients (83.3%) achieved primary reattachment with no retinal displacement or outer retinal folds, and these patients were able to resume normal activity immediately after the procedure, with no restrictions. The mean (SD) logMAR VA at 3 months was +0.46 (0.34) (Snellen 20/57), and the mean (SD) logMAR VA at the last postoperative assessment was +0.30 (0.17) (Snellen 20/40). The mean (SD) duration of the 0.6 mL of sodium hyaluronate, 2.3%, in the SCS assessed with SS-OCT was 16.0 (5.3) days. Multimodal imaging confirmed the viscoelastic’s presence in the SCS for 10, 14, 21, 13, 24, and 14 days for each case, respectively, and the retina remained attached during the postoperative follow-up period. One patient developed a localized choroidal effusion unrelated to the SCVEXY site following laser retinopexy that resolved in 1 week. The resolution was associated with topical prednisolone, 1%, 4 times daily, and cyclopentolate, 1%, twice daily. Two patients (33.3%) had subconjunctival viscoelastic immediately after the procedure, which resolved in the following days without any issue. Two patients (33.3%) had nonperfusion of the CRA immediately after the viscoelastic injection. A small AC paracentesis was performed in these cases, which immediately restored perfusion (results summarized in eTables 1-3 in Supplement 1).
Case 1
A 39-year-old male patient with vision loss for 5 days in the right eye was referred for RRD. VA was HM with a history of intracameral contact lenses. There was an inferotemporal RRD from the 5- to 10-o’clock positions, with inferior causative break located at the 8-o’clock position (eFigure 1 in Supplement 1). SCVEXY achieved reattachment on day 3, and laser retinopexy was performed. VA was 20/50 at 3 months postoperative follow-up. VA was limited by a secondary anterior subcapsular cataract that was present at baseline related to the prior intracameral contact lens. Patient underwent cataract surgery and VA improved to 20/40 at the 17-month postoperative assessment. There was no retinal displacement or outer retinal folds. The patient had residual SFF that improved over time (eFigures 1F and 1G, in Supplement 1).
Case 2
A 58-year-old female patient presented with a 3-week history of vision loss to CF in the left eye and a fovea-off RRD from the 1-o’clock position to the 5:30 position, with a large horseshoe tear located at the 3- to 4-o’clock position (Figure 1A). SS-OCT foveal scans demonstrated patchy loss of photoreceptor inner and outer segments (Figure 1E). The patient was concerned regarding positioning and, following a thorough discussion, decided to proceed with SCVEXY. AC paracentesis was performed following the injection of the viscoelastic to restore CRA perfusion.
Figure 1. Longitudinal Progression of Retinal Reattachment on Multimodal Images.
Ultra-widefield fundus images demonstrating fovea involving rhegmatogenous retinal detachment (RRD), with a large horseshoe tear (HST) at the 3-o’clock position in the left eye (A). Retinal reattachment was achieved at postoperative day 1 following in-office suprachoroidal viscopexy with laser retinopexy applied around the temporal tear (B), and postoperative assessment performed at 8 months demonstrated anatomic reattachment with mature laser scars around the HST (C). Fundus autofluorescence images demonstrated high-integrity retinal reattachment without retinal displacement (D). Consecutive swept-source optical coherence tomography (SS-OCT) foveal scans illustrating morphologic stage 5 RRD, characterized by a moth-eaten appearance of the photoreceptors (E), SS-OCT scans demonstrating foveal reattachment at postoperative day 1 (F) and at month 8 (G), with no evidence of outer retinal folds.
Macular reattachment was achieved in less than 24 hours, and laser retinopexy was completed on day 1 (Figure 1B). The patient was able to resume normal activity immediately after the procedure, with no restrictions. No retinal displacement, outer retinal folds, or persistent SFF was evident at 3 months. The suprachoroidal viscoelastic was absorbed in 2 to 3 weeks postoperatively, and the retina remained attached at the 1-year postoperative assessment, with a final VA of 20/40 (Figure 1C).
Case 3
A 62-year-old male patient presented with VA of 20/100 OD and nasal visual field defect for 3 days with a fovea-off temporal RRD and horseshoe tear at the 8:30 clock position (eFigure 2A in the Supplement). In-office SCVEXY was performed on the same day (Video 2), and a good suprachoroidal buckle in the region of the horseshoe tear (HST) was achieved. At day 1, the retina was attached, and laser retinopexy was performed (eFigure 2B in Supplement 1). No positioning was required, and the patient resumed all work and leisure activities immediately after the procedure (Video 3). At the 3-month follow-up, his VA was 20/40, and the retina remained attached, with no outer retinal folds on OCT and no signs of RVPs on fundus autofluorescence imaging (eFigure 2D in Supplement 1). Residual SFF persisted at the 3-month postoperative assessment, and final assessment VA was 20/40 (eFigures 2F and 2G in Supplement 1). This patient had some subconjunctival viscoelastic immediately after the procedure, which resolved in days.
Video 2. In-Office Suprachoroidal Viscopexy for Acute Rhegmatogenous Retinal Detachment, Patient 3.
Suprachoroidal viscopexy was performed in the office setting under subconjunctival anesthesia and direct visualization with indirect ophthalmoscopy.
Video 3. Patient Interview a Few Days After the Suprachoroidal Viscopexy Procedure.
Case 4
A 50-year-old male patient presented with decline in vision over 2 weeks. Visual acuity was 20/100 OD with a temporal fovea-involving RRD from the 7- to 10-o’clock position, with an HST at the 9-o’clock position (Figure 2A).
Figure 2. Serial Multimodal Images Showing Progressive Reattachment of the Retina Following Suprachoroidal Viscopexy (SCVEXY).
Serial color fundus images and fundus autofluorescence (FAF) (D) demonstrated a macula-off rhegmatogenous retinal detachment (RRD) extending from the 7- to 10-o’clock position and a temporal HST in the right eye (A). The retina was fully reattached at postoperative day 1, with laser retinopexy applied around the temporal break (B), and 4-month follow-up assessment showed anatomic reattachment of the retina (C). FAF image illustrating high-integrity retinal reattachment with no visible retinal vessel printings (D). Corresponding sequential SS-OCT foveal scans captured at the same time points as the fundus images show morphologic stage 3 RRD at baseline (E) and foveal reattachment on postoperative day 1, with viscoelastic in the suprachoroidal space (arrowheads) (F). Month 4 postoperatively showed no evidence of residual subretinal fluid or outer retinal folds (G).
The patient’s history of early-onset Parkinson disease, combined with his active employment, heightened concerns regarding positioning. In-office SCVEXY was performed. On day 1, a complete reattachment was achieved, with VA returning to 20/60 (Figure 2B), and laser retinopexy was completed. At 9 months, the retina remained fully attached, with no evidence of outer retinal folds, residual SFF, or retinal displacement with fundus autofluorescence imaging (Figure 2C-G). VA improved to 20/50 at final follow-up.
Case 5
A 62-year-old male patient presented with nasal retinal detachment between the 1:30 to 4:30 clock position and a break at the 2-o’clock position in the right eye (eFigure 3A in Supplement 1). SCVEXY was performed (Video 4). A satisfactory indentation was achieved, and the patency of the CRA was assessed and found to be nonperfused immediately after the injection. Subsequently, an AC paracentesis removing 0.1 mL was performed, which restored perfusion immediately. On day 1, the SRF was reduced, and the superior and anterior aspect of the break was lasered. Laser retinopexy was completed on day 5 (eFigure 3B in Supplement 1). On day 7, the patient had a temporal choroidal effusion that resolved with topical steroids and cycloplegics. The retina remained attached at month 8 without retinal displacement or outer retinal folds and a VA of 20/20. (eFigures 3C-3G in Supplement 1).
Video 4. In-Office Suprachoroidal Viscopexy for Acute Rhegmatogenous Retinal Detachment, Patient 5.
Suprachoroidal viscopexy was performed in the office setting under subconjunctival anesthesia and direct visualization with indirect ophthalmoscopy.
Case 6
A 70-year-old female patient presented with HM vision OD and a fovea-involving temporal RRD from the 6- to 11-o’clock position, with an HST at the 9:30 clock position and no pathology in the attached retina. SCVEXY was performed, and a dome-shaped indentation was visualized, confirming the suprachoroidal buckle creation (eFigure 4 in Supplement 1). The choroidal indentation appeared to be too anteriorly placed and did not cover the posterior aspect of the tear. This patient had some subconjunctival viscoelastic after SCVEXY that resolved over a few days. The retina was still detached with an open retinal break on day 5 and PnR was performed. On day 1 following PnR, the retina was attached and laser retinopexy was completed (eFigures 4C and 4D in Supplement 1). At month 3, the retina remained attached, with no retinal displacement or outer retinal folds. VA assessed at the final follow-up at 10 months postoperatively was 20/70.
Discussion
SCVEXY is a minimally invasive, in-office procedure that involves delivering viscoelastic into the SCS to create a temporary suprachoroidal buckle (Video 1, Figure 3). This case series provides follow-up on 6 patients with RRDs treated with SCVEXY, with a mean (SD) follow-up duration of 383.3 (71.1) days and a maximum follow-up duration of 510 days. In all patients, 0.6 mL of viscoelastic was injected in the SCS, as this quantity aligns with the amount in a syringe of commercially available sodium hyaluronate, 2.3%, which was found sufficient to create an effective suprachoroidal buckle. Furthermore, we have considerable experience administering 0.6 mL of pure sulfur hexafluoride gas (SF6) in PnR, a well-tolerated procedure where AC paracentesis is performed as needed. Long-term data on the toxicity or potential adverse events of sodium hyaluronate, 2.3%, and other viscoelastic agents in the SCS remain limited. Thus far, no signs of toxicity have been observed in any patients for whom a viscoelastic agent was injected. The suprachoroidal buckle was successfully created in all 6 patients (100%), and 5 patients (83.3%) achieved primary anatomic reattachment. Indirect laser was performed on day 1 following SCVEXY in half the cases (3 cases). In the remaining cases, laser retinopexy was initiated once any part of the break was attached and was completed on the 3rd and 5th days. The suprachoroidal indentation facilitated the laser application. Although there was a tendency to avoid or minimize scleral indentation to avoid possibly displacing the viscoelastic, in some cases a small amount of scleral depression was necessary. No displacement of viscoelastic following scleral indentation was noticed. Cryotherapy was not used; however, its application may be considered for anterior breaks or smaller retinal tears in future cases. A potential drawback of cryopexy is the risk of inducing hypotony, which could make the procedure more challenging and increase risks.
Figure 3. Ultra-Widefield (UWF) Fundus Photo and UWF-Guided Swept-Source Optical Coherence Tomography (OCT) Scans Demonstrating Viscoelastic in the Suprachoroidal Space.
UWF-guided swept-source OCT scans (A) and corresponding locations (1-3) on fundus image (B) acquired at postoperative day 1 following suprachoroidal viscopexy in the right eye of a patient who underwent rhegmatogenous retinal detachment (RRD) repair demonstrating viscoelastic in the suprachoroidal space. Hyporeflective space between the choroid and the sclera indicates the location of viscoelastic (arrowheads).
As a nondrainage procedure grounded in the principles of fully using the RPE pump, SCVEXY can potentially allow for a natural reattachment of the retina without a tamponade. The impact of gas tamponade on the pathophysiology of retinal displacement has been extensively studied.7,8,16 As SCVEXY does not necessitate postoperative positioning, with patients able to resume normal work and leisure activities immediately following the procedure, SCVEXY offers the potential to be the most patient-friendly treatment option for certain RRDs, while potentially maximizing both functional and anatomic outcomes. The ability to tell patients that they can resume normal activity immediately after the procedure is a substantial step forward in the management of RRD.
High-integrity retinal reattachment (HIRA) was consistently achieved in all cases, as evidenced by the absence of RVPs on fundus autofluorescence imaging (Figure 2, Figure 3D). Furthermore, during the postoperative month 3 assessment, none of the patients exhibited outer retinal folds, likely due to the adequate time provided in stage 2 of retinal reattachment for outer retinal corrugations to resolve prior to contact of the retina with RPE.17
Consistent with its mechanism of action, SCVEXY may take longer to achieve foveal reattachment. Two of 5 patients who had successful SCVEXY (40%) had persistent SFF during the early postoperative days, which resolved over time. This would be similar to the results expected with a nondrainage scleral buckle, which is a technique first proposed by Custodis in the 1950s and advocated for by Lincoff and Kreissig in the later part of the 20th century. We have studied persistent SFF in the setting of a post hoc analysis of a randomized clinical trial comparing PnR vs pars plana vitrectomy and found that although SRF may persist with nondrainage procedures, such as PnR (and with SCVEXY), this does not have a long-term impact on Early Treatment Diabetic Retinopathy Study VA.18 We have shown in other studies2,13 that structural damage to the outer retina occurs when there is access of hypo-osmolar liquified vitreous to the subretinal space (dysregulated status). Once the break is closed and the RPE has regained control, although some residual fluid may be left behind, we hypothesize that the photoreceptors are in a regulated state.13
The mean (SD) duration of 0.6 mL of sodium hyaluronate, 2.3%, in the SCS assessed with SS-OCT was 16.0 (5.3) days, with a useful suprachoroidal buckling effect for 10 to 14 days. One patient had SCVEXY failure, attributed to the anterior injection of viscoelastic, which led to insufficient suprachoroidal indentation at the posterior margin of the break. Subsequently, in-office PnR was performed with retinal reattachment the following day. PnR remains an excellent first-line procedure and may also serve as a viable rescue technique in the event of SCVEXY failure. Additional procedures are often performed concurrently with vitrectomy or scleral buckle, such as drainage or gas injection, to increase the primary reattachment rate,19,20,21 and SCVEXY could benefit from similar complementary approaches. In addition, SCVEXY could potentially be used as an adjunct to techniques such as PnR or pars plana vitrectomy, particularly for inferior breaks.
In some cases, there was nonperfusion of the CRA on clinical assessment immediately after the viscoelastic injection. As demonstrated in 2 cases, AC paracentesis may be required to restore perfusion in a timely manner, as is commonly done with PnR and scleral buckle. Despite this, we recommend a slow, delayed paracentesis and only if required to maintain intraocular pressure and reduce the risk of hemorrhage. Another adverse event was a localized choroidal effusion following laser treatment in 1 case in the quadrant opposite the SCVEXY site. This was believed to be related to postlaser inflammation and resolved in 1 week associated with topical therapy. Lastly, subconjunctival viscoelastic was observed in 2 patients following SCVEXY, but it resolved within a few days without any complications.
Although no severe adverse effects were encountered, the small sample size limits our ability to definitively determine safety. However, it is important to note that the true risk of adverse events, including potential unknown risks, such as intraocular perforation, the toxicity of the viscoelastic, or choroidal and subretinal hemorrhage, cannot be determined from this dataset.
Another important consideration is the impact of scleral thickness and its biomechanical properties on SCVEXY. Additionally, the SCS is a potential space that may have fluid in the context of retinal detachment, which may facilitate SCVEXY.22 Understanding the variability in scleral thickness and the thickness of the SCS is essential, and we are conducting additional research to further investigate these factors. Although we did not assess scleral thickness in the current cohort, patients with very thin sclera may face increased risks of adverse events with the current technique. We anticipate that these risks will be mitigated with advancements in technique and device development over time. Thus, continued caution is warranted, and future studies with larger sample sizes and longer-term follow-up will be essential for a more comprehensive safety assessment.
Lastly, SCVEXY’s early outcomes, with an 83% primary anatomic reattachment rate and VA of approximately 20/40, are modest compared to established techniques. It is worth noting that the primary anatomic reattachment rate for SCVEXY may be comparable to other in-office techniques, such as PnR, which has reported success rates ranging from 70% to 90% in various studies.10,23,24,25,26,27,28 VA variability at baseline among cases and limited data prevent direct comparisons with other established techniques, and more prospective studies are needed to better assess outcomes. Ongoing refinements are expected to improve outcomes, and we anticipate better results with further experience in future studies.
Limitations
This study has several limitations. As SCVEXY is a new procedure, the small sample size of 6 uncontrolled cases does not allow for a determination of efficacy. A more definitive evaluation would require randomized data comparing SCVEXY to the standard of care, which was beyond the scope of this study. Additionally, the retrospective nature of this analysis could introduce selection bias and publication bias. Finally, the follow-up period for most cases was 1 year or less (whereas current standard procedures have multiple years of follow-up), and future studies with longer-term prospective data will be required. Despite these limitations, this study offers a valuable proof of concept for the potential of SCVEXY as a new technique for RRD repair.
Conclusions
In this case series, these 6 cases support the potential feasibility of in-office SCVEXY as a technique for repairing RRD. If future randomized clinical trial data with adequate sample size and follow-up show comparable or improved outcomes compared to current methods, SCVEXY may offer benefits, such as avoiding postoperative positioning and maximizing functional outcomes and anatomic outcomes of integrity. Currently, SCVEXY is used in select cases with temporal or nasal retinal tears that are accessible with the current device and technique. As the device and technique are further developed, the indications may expand as well. Further research is needed to refine case selection and evaluate the efficacy, adverse events, and failure rates.
eTable 1. Baseline Characteristics
eTable 2. Anatomical and Functional Outcomes at the 3 Months Postoperative Follow-Up and Final Assessment
eTable 3. Anatomical Outcomes of Integrity
eFigure 1. Sequential Ultra-Widefield Fundus Imaging and Optical Coherence Tomography Foveal Scans (Case 1)
eFigure 2. Sequential Ultra-Widefield Fundus Imaging and Optical Coherence Tomography Foveal Scans (Case 3)
eFigure 3. (Case 5) Sequential UWF Fundus Images Demonstrating Nasal Rhegmatogenous Retinal Detachment Following Suprachoroidal Viscopexy
eFigure 4. Sequential Ultra-Widefield Fundus Images and Optical Coherence Tomography Foveal Scans (Case 6)
Data Sharing Statement
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
eTable 1. Baseline Characteristics
eTable 2. Anatomical and Functional Outcomes at the 3 Months Postoperative Follow-Up and Final Assessment
eTable 3. Anatomical Outcomes of Integrity
eFigure 1. Sequential Ultra-Widefield Fundus Imaging and Optical Coherence Tomography Foveal Scans (Case 1)
eFigure 2. Sequential Ultra-Widefield Fundus Imaging and Optical Coherence Tomography Foveal Scans (Case 3)
eFigure 3. (Case 5) Sequential UWF Fundus Images Demonstrating Nasal Rhegmatogenous Retinal Detachment Following Suprachoroidal Viscopexy
eFigure 4. Sequential Ultra-Widefield Fundus Images and Optical Coherence Tomography Foveal Scans (Case 6)
Data Sharing Statement