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 diflupred-nate, 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.