Persistent pigment epithelial detachment (PED) is a challenge in treatment-resistant polypoidal choroidal vasculopathy (PCV) , . Here, we reported fluids aspiration with 41-gauge needle in a PCV patient showing immediate PED regression in surgery and sustained effect in 6 months observation.
After a standard 25-gauge, 3-port pars plana vitrectomy (PPV) (Constellation, Alcon, Texas American), intra-operative optical coherence tomography (iOCT) imaging system (ARTEVO 800 OCT, ZEISS, German) was used for localizing the area of PED ( Video, step 1 ). Neural retina and pigment epithelial penetration avoiding central fovea was achieved via the 41-gauge needle (NANO SubRet CURVED GATEWAY DEVICE, Vortex Surgical, USA) ( Video, step 2 ). After the successful penetration, fluids aspiration was done by increasing the vacuum pressure via the Alcon Constellation silicon injector (VFC) and supplied silicon injection cannula. Immediate regression was observed when the vacuum pressure was increased over than 300 mmHg ( Video, step 3, yellow arrow ). Half air-fluid exchange was carried out and 2.0 mg Aflibercept was injected into vitreous cavity at the end of surgery (Not shown in Video).
This patient eye showed limited response to prior 10 months treatments including three loading doses of Aflibercept, one of Conbercept and three of faricimab-svoa ( Figure 1 in Video ). Fluids aspiration immediately relieved the PED in his eye and the effect was sustained in 6 months observation ( Figure 2 in Video ). Slightly increased sub-retinal fluids were observed at 6 months’ visit ( Figure 2 in Video ). His visual acuity was improved from 20/66 to 20/50 at 1 month visit. No serious retina or retinal pigment epithelial damage at the penetration site was observed ( Figure 3 and Figure 4 in Video ).
