Suprachoroidal buckling

Purpose: To evaluate the feasibility of suprachoroidal buckling procedure using a suprachoroidal catheter, or cannula, as a new approach to treating different forms of retinal detachment, including myopic traction maculopathy, myopic macular holes, and peripheral retinal breaks by creating a suprachoroidal indentation (buckling effect) using a suprachoroidal filler.

Methods: We used specially designed devices, guided in the suprachoroidal space to reach the target space (retinal tear). Then we injected a suprachoroidal filler (long-lasting hyaluronic acid) to indent the choroid creating a suprachoroidal buckle to close retinal tears and support the retina. This was done to both central (myopic macular) holes in areas of the staphyloma as well as for treating peripheral retinal breaks. This technique can be used alone or during vitrectomy.

Results: In myopic patients, retinal layer restoration was achieved in all eyes with myopic foveoschisis. Of the 12 eyes, 10 with macular hole detachment (83%) showed closure of the holes in association with the resolution of the detachment; 2 eyes showed resolution of the detachment and flattening of the edge of the holes, but with incomplete closure on optical coherence tomography. Eight eyes (66.6%) showed improvement in visual acuity by one or more lines with no recurrence of retinal detachment over the 24-month follow-up period. The indentation effect was sufficient over the 24-month follow-up period. For peripheral retinal breaks, tears treated with this technique were all adequately buckled and closed from one procedure. A well-controlled location and support distribution of the buckle was possible through the suprachoroidal space. The buckling effect was enough to seal the tears and support the chorioretinal scarring time needed for tear healing. This also could be controlled by the filler duration time (filler type). The procedure was safe and relatively simple in reaching the treatment area and injecting it.

Conclusion: The indentation effect achieved by the suprachoroidal approach can be used as a method for managing myopic foveoschisis and myopic macular hole with detachment even in eyes with failed primary vitrectomy, counteracting the role of posterior staphyloma in the role of the disease. This technique is also feasible for treating retinal tears, supporting the retina, and treating selected forms of retinal detachment including subsilicone inferior recurrent retinal detachment. It can be done separately or in association with vitrectomy procedures. It adds to our surgical options in treating selected cases of rhegmatogenous retinal detachment and avoids some potential problems of episcleral buckles as well as vitrectomy in selected cases of rhegmatogenous retinal detachment.