Hemorrhagic complications associated with suprachoroidal buckling

Fares Antaki; Ali Dirani; Marina Ravagnani Ciongoli; David H W Steel; Flavio Rezende

doi:10.1186/s40942-020-00211-6

Hemorrhagic complications associated with suprachoroidal buckling

Int J Retina Vitreous. 2020 Apr 16:6:10. doi: 10.1186/s40942-020-00211-6. eCollection 2020.

Authors

Fares Antaki^#¹, Ali Dirani^#^{1

2}, Marina Ravagnani Ciongoli³, David H W Steel^{4

5}, Flavio Rezende¹

Affiliations

¹ 1Department of Ophthalmology, Hôpital Maisonneuve-Rosemont, Université de Montréal, 5415 Assumption Blvd, Montréal, QC H1T 2M4 Canada.
² 2Centre Universitaire d'Ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec-Université Laval, Québec, QC Canada.
³ 3Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil.
⁴ 4Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.
⁵ 5Sunderland Eye Infirmary, Sunderland, UK.

^# Contributed equally.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Hemorrhagic complications; Retinal detachment; Suprachoroidal buckling; Viscoelastic buckling.