Preoperative Intravitreal Viscoelastic Injection (PIVOT) for Surgical Optimization in Rhegmatogenous Retinal Detachment With Choroidal Detachment.

BACKGROUND AND

OBJECTIVE

Rhegmatogenous retinal detachment with choroidal detachment (RRDCD) is a challenging situation. This study evaluates the safety and efficacy of preoperative intravitreal viscoelastic injection (PIVOT) in facilitating vitrectomy in RRD-CD.

PATIENTS AND

METHODS

This consecutive series included eight eyes of eight patients with RRD-CD (CD reaching to equator), managed between December 2024 and April 2025. Healon™ PRO (1% sodium hyaluronate) was injected intravitreally, typically one day prior to vitrectomy, along with topical difluprednate, cycloplegics, and oral corticosteroids. Outcome measures were intraocular pressure (IOP), cumulative CD height (by ultrasonography), injection-related adverse events, and intraoperative complications.

RESULTS

Mean IOP increased from 4.75 ± 2.05 mmHg at baseline to 10.0 ± 3.34 mmHg on day of surgery (P = .001). Cumulative CD reduced from 15.82 ± 4.88 mm to 5.49 ± 6.01 mm (P = .003). No adverse events were noted. Vitrectomy was safely completed, ensuring adequate silicone oil fill in all eyes.

CONCLUSION

PIVOT combined with anti-inflammatory treatment appears safe and effective in optimizing surgical conditions for RRD-CD.