Researchers Develop Minimally Invasive Technique for Retinal Detachment

A retinal surgeon and researcher at St. Michael's Hospital has introduced a novel, minimally-invasive method for addressing retinal detachment. This procedure eliminates the need for incisions and can be performed within the ophthalmologist's office. It also might facilitate speedier healing for patients, enabling them to promptly resume their daily activities, including work.

The technique, referred to as "suprachoroidal viscopexy" (SCVEXY), is detailed in a recent study published in JAMA Ophthalmology.

"St. Michael's is an international leader in the management of retinal detachment, having carried out many key ophthalmology clinical trials," said Dr. Rajeev Muni vitreoretinal surgeon at St. Michael's and lead author of the study. "The trials we have done at St. Michael's have demonstrated that less is more with retinal detachment repair."

Retinal detachment occurs when the sensitive tissue layer at the back of the eye, known as the retina, separates from its usual position. This serious condition leads to abrupt alterations in vision, including the perception of floaters and flashes, blurred vision, and diminished peripheral vision. Failing to promptly address retinal detachment can result in lasting and severe vision impairment.

The predominant form of retinal detachment is called rhegmatogenous retinal detachment (RRD), which transpires when a rift or tear manifests in the retina. This tear permits the gel-like fluid in the eye's central area to infiltrate behind the retina, prompting detachment from adjacent tissue.

Numerous current methods for rectifying retinal detachment necessitate invasive surgical procedures in an operating room setting. Alternatively, an existing in-office approach known as pneumatic retinopexy involves injecting gas into the eye to reposition the retina. While this technique is less invasive than other operating room procedures, it still presents drawbacks. Patients are required to assume specific positions and curtail regular activities for about a week post-procedure due to the injected bubble, according to Muni.

Muni and the research team describe their innovative procedure's application at St. Michael's in their study. This technique entails injecting viscoelastic, a gel-like substance commonly used in eye surgery, into the suprachoroidal space within the eye. This creates an indentation at the site of the retinal tear, effectively closing it. The study reports that less than 24 hours after the procedure, the retina displayed substantial reattachment.

"We have demonstrated the ability to inject viscoelastic into the suprachoroidal space without incisions and in a way that can be done in the office," Muni said. "This could lead to some patients having their retinal detachment fixed, while allowing them to return to regular activities the following day."

Employing minimally invasive approaches while steering clear of fluid drainage and sizable gas bubbles may lead to enhanced "integrity" of the retinal attachment through this innovative method, he further explained.

According to Muni, the team's future endeavors include conducting additional procedures on patients with retinal detachment, thereby accumulating experience across diverse clinical contexts. Additionally, the team has initiated a patent application for a device aimed at streamlining the procedure and facilitating the injection of the viscoelastic substance into the suprachoroidal space.

"We have spent the last 10 years trying to find better ways to reattach the retina as close as possible to its original position to optimize the quality of vision for patients. This is a new in-office technique where patients may be able to have their retina attached without an incision, a gas bubble injection or strict positioning, potentially allowing them to return to all their usual activities almost immediately," he said.

Reference

Rajeev H. Muni et al, In-Office Suprachoroidal Viscopexy for Rhegmatogenous Retinal Detachment Repair, JAMA Ophthalmology (2023). DOI: 10.1001/jamaophthalmol.2023.3785