Muni Rajeev H, Melo Isabela Martins, Demian Sueellen, Minelli Tomas, Batawi Hatim, Park John, Pecaku Aurora
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
Department of Ophthalmology, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
JAMA Ophthalmol. 2025 Jan 1;143(1):53-60. doi: 10.1001/jamaophthalmol.2024.5202.
In-office suprachoroidal viscopexy (SCVEXY) is a relatively new procedure for rhegmatogenous retinal detachment (RRD), but minimal information is available regarding outcomes and safety.
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.
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.
The primary outcome was primary anatomic reattachment rate with SCVEXY and recovery of function and anatomic integrity.
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.
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.
诊室脉络膜上腔黏弹剂固定术（SCVEXY）是一种用于孔源性视网膜脱离（RRD）的相对较新的手术，但关于其疗效和安全性的信息极少。
报告诊室SCVEXY治疗原发性急性RRD的疗效。
设计、设置和参与者：本回顾性病例系列于2023年6月至2024年2月在加拿大多伦多圣迈克尔医院对连续的原发性急性RRD患者进行，这些患者的视网膜裂孔可通过当前诊室SCVEXY技术在颞侧或鼻侧视网膜触及。
使用带有定制护罩的30号针头在裂孔部位脉络膜上腔注射0.6 mL 2.3%的透明质酸钠。视网膜复位后在裂孔周围进行激光视网膜光凝。
主要结局是SCVEXY后的原发性解剖复位率以及功能和解剖完整性的恢复。
6例患者中，2例（33.3%）为女性，患者平均（标准差）年龄为52.5（19.7）岁。每位患者的最终随访时间分别为510、420、360、360、330和320天。患者1至6的基线视力分别为手动、数指、20/100、20/100、20/25和手动。术后所有病例均出现穹窿状脉络膜上腔扣带。6例患者中有5例（83.3%）实现了解剖复位，无视网膜移位或视网膜外层皱褶，这些患者术后可立即恢复正常活动，无限制。3个月时平均（标准差）logMAR视力为+0.46（0.34）（Snellen 20/57）。多模态成像证实，黏弹剂在脉络膜上腔分别持续存在10、14、21、13、24和14天，整个术后随访期间视网膜保持附着。1例患者的SCVEXY因视网膜裂孔后缘黏弹剂不足而失败，该患者接受了成功的气体视网膜固定术。1例患者在激光视网膜光凝后出现与SCVEXY部位无关的局限性脉络膜积液，使用1%的局部泼尼松龙每日4次和1%的环喷托酯每日2次，1周内积液消退。
在本病例系列中，这6例患者的结果表明，SCVEXY可能为RRD提供持久的视网膜复位。然而，与标准治疗相比，需要随机临床试验数据、更大样本量和更长时间的随访来评估SCVEXY的风险效益概况。
