Custom Needle Setup and Choroidal Indentation Following Combined Vitrectomy and Intraoperative Suprachoroidal Viscopexy Using Viscous Fluid Control Injection

Combined pars plana vitrectomy and suprachoroidal viscopexy (SCVEXY) were performed for additional support of the inferior temporal breaks in a macula-off detachment with multiple breaks. This video highlights the part of the procedure in which the SCVEXY is being performed intraoperatively. The transconjunctival suprachoroidal injection of sodium hyaluronate, 2.3%, viscoelastic agent (Healon 5; Abbott Medical Optics) was carried out in the inferior temporal quadrant under subconjunctival anesthesia, using a 30G needle with a custom-made guard made using intravenous tubing (CHS Med-RX Lot 165225). The guard was made such that only 1 mm of the needle length was exposed. Prior to the injection, the site was verified internally under the microscope as being under the center of the retinal breaks, and the needle position was confirmed to not be too deep. While 0.4 mL of viscoelastic was injected under direct visualization using the viscous fluid control of the vitrectomy machine, a dome-shaped choroidal elevation formed. Click the Related Article link for full details.