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Kai Januschowski, Karl Boden, Peter Szurman; Suprachoroidal hydrogel buckling as a surgical treatment of retinal detachment - biocompatibility and first experiences. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1036.
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© 2017 Association for Research in Vision and Ophthalmology.
The surgical treatment of retinal detachment is based on identifying and closing the causative retinal break. Both buckling surgery and vitrectomy are the two established surgical procedures. Although they might seem diametrically opposed at first glance, both techniques follow the principle of approximating and fixating the detached retina, either ab externo (buckle, cryokoagulation) or ab interno (tamponade, endolaser). Although we have witnessed continuous technical refinements in the recent past, the basic principle remained unchanged.It was our goal to evaluate a novel technique for surgical treatment of retinal detachment combining the advantages of both vitrectomy and buckling surgery.
In 4 rabbits a suprachoroidal buckle via a sclerotomy and injection of a hydrogel was created. After 4 weeks histologic analysis was performed. For patients a 23 Gauge approach with placement of a buckle directly under the retinal break with either crosslinked or non-crosslinked hyaluronic acid depending on the intraoperative need was performed.
All rabbits showed no histological damage to the retina. In total, 21 patients were successfully treated with both methods (15 with the combined method had one or multiple breaks, 6 patients with only one retinal break received the stand-alone procedure). After 8 weeks the retina remained reattached, The non-crosslinked buckles showed an indentation effect for 5-7 d (median 7 d), while the crosslinked hydrogels were observed to exert their effect for about 8 weeks.A non-crosslinked hyalouronic acid buckle was created in 14 patients, while 7 patients received a crosslinked hyalouronic acid buckle. 6 patients received SF6, 4 patients received air.
We demonstrated good biocompatibility in the rabbit model and promising results in our first patients.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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