Suprachoroidal Buckle for Rhegmatogenous Retinal Detachment
This is a video shared by Dr. Audrey Juan from Santo Domingo Dominican Republic.
This is a case of a 35 years old Female with progressive decreased VA in OD in the last 2 months.
As ocular conditions, patient had a previous history of RRD in the left eye treated with Cryopexy and Scleral Buckle 12 years ago.
Her BCVA was 20/400 in the right eye and 20/100 in the left eye.
In the Fundoscopy she had a macula Off Temporal retinal Detachment, with a single small hole superotemporally in the periphery.
Surgeon has decided to perform Suprachoroidal Buckle and Cryopexy for the treatment of this case. In this technique a cannula is guided in the suprachoroidal space to reach the target area and then a suprachoroidal filler is injected to create a temporary buckling to close retinal tears and supporting the overlying retina.
A conjunctival peritomy was performed temporally in the side of the hole followed by cauterization of the sclera. Then she placed a Chandelier light so the Cryo could be done under BIOM visualization.
An anterior chamber paracentesis was done to avoid increase of IOP during the suprachoroidal injection. Then a 3 mm incision was made 4 mm to the limbus, using a crescent blade to introduce the 23- Gauge Olive tip cannula.
Olive Tip cannula is a curved cannula designed for suprachoroidal surgery. Note that the large and rounded tip allows gentle placement of filler material in the suprachoroidal space creating a buckle effect.
So, again under BIOM visualization, you can inject long-lasting Hyaluronic acid (Restylane) – that lasts about 2-3 months; or Viscoelastic (Healon GV or Healon 5) – that lasts 3-4 weeks. You can inject until to get the desired indentation. In the end of the surgery the sclera and conjunctiva are sutured.
This patient had a good outcome and three weeks after surgery, it was improvement in the VA and the indentation was still visible. The lesion was sealed, but there was yet a residual subretinal fluid in the posterior pole. Three months after the surgery retina was totally attached with adequate chorioretinal scaring.
As advantages, we can avoid potential problems of episcleral buckling, reducing refractive changings and postoperative discomfort with this technique.
Audrey Juan MD
Santo Domingo – Dominican Republic
Filipe Lucatto MD
Juliana Prazeres MD
Salvador – Brazil