Antaki Fares, Dirani Ali, Ciongoli Marina Ravagnani, Steel David H W, Rezende Flavio
1Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Assumption Blvd, Montréal, QC H1T 2M4 Canada.
2Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Québec, QC Canada.
Int J Retina Vitreous. 2020 Apr 16;6:10. doi: 10.1186/s40942-020-00211-6. eCollection 2020.
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.
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.
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.
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.
存在多种用于修复孔源性视网膜脱离（RRD）的手术技术。脉络膜上腔扣带术（SCB），即向脉络膜上腔注射粘弹性材料以使脉络膜视网膜贴附，最近已被用于RRD的修复。本研究的目的是报告SCB的并发症，并提出在学习曲线期间降低其发生率的措施。
纳入26例患者的26只眼，这些患者因单个或多个视网膜裂孔继发RRD而接受了SCB手术。患者于2014年1月至2017年3月在两家学术机构接受手术。从病历中获取患者和视网膜脱离的特征。对每个病例的手术视频进行回顾，并记录术中并发症。术后观察到的并发症从病历中获取。
16只眼（62%）仅接受了SCB，5只眼（19%）接受了额外的气体填塞，5只眼（19%）进行了联合玻璃体切割术。最常见的并发症是出血（6例，23%）。在隆起边缘没有缺血性脉络膜改变或色素沉着的病例。所有6例并发症均发生在有下方RRD且下方象限有视网膜裂孔的有晶状体眼患者中。4例患者发生孤立性视网膜下出血，1例患者发生孤立性脉络膜上腔出血，这些均未影响最终视力结果。1例发生广泛的视网膜下和脉络膜上腔联合出血，并伴有眼球痨。4/6（67%）的患者发生再脱离，5/6（83%）的患者需要二次手术。6例患者中有3例（50%）视力至少提高了2行。
用于RRD的SCB可能与出血性并发症相关。出血通常是自限性的，但当累及脉络膜上腔时偶尔可能导致严重的视力损害。需要采取特定的手术措施以降低并发症的可能性，并且需要进一步研究来评估该技术的安全性和有效性。
