Novel Surgical Pathway for Controlled Access to the Subretinal Space: A Case Series

PURPOSE: We report a case series demonstrating a novel technique to access the subretinal space through a trans-scleral approach. METHODS: This was a prospective, interventional case series. All 25 cases underwent three-port vitrectomy using CONSTELLATION Vision System (Alcon. Laboratories, Inc., Fort Worth, TX) and NGENUITY 3D Visualization System. In all cases a fourth 25G valved cannula was inserted posteriorly in the vitreous cavity to secure a controlled access to the subretinal space. This route was used to remove subretinal fibrosis, drain subretinal fluid, and inject vital dye to identify an occult retinal break in some cases. RESULTS: In 23 of 25 cases, the retina remained attached postoperatively after a single surgery, and vision improvement was observed. In two cases, the retina was attached after an additional procedure. Although mild subretinal hemorrhage was seen in three cases, no other major complication was observed. CONCLUSIONS: Access to the subretinal space by a posteriorly placed fourth valved cannula is safe and helps in subretinal fibrosis removal and drainage of subretinal fluid and can be useful in complicated retinal detachments. TRANSLATIONAL RELEVANCE: This case series uses knowledge acquired from developing small gauge microincision instruments for pars plana vitrectomy to present a novel clinical application applicable to difficult, complex retinal surgeries.