Simplified suprachoroidal buckling: sclerotomy-free viscoelastic injection with a novel device in porcine eyes

To evaluate the technical feasibility of a standardized, sclerotomy-free method for injecting viscoelastic material into the suprachoroidal space using a novel mechanical injector, and to evaluate an upgraded injector version in an ex vivo porcine model. This laboratory investigation was conducted at a central medical research center using thirteen freshly enucleated pig eyes obtained from a local farm. All eyes underwent a 360-degree peritomy and were fixed to a Styrofoam platform. In cohort 1 (n = 5), a custom mechanical injector (Supra SEG) with a 30-gauge needle and selectable penetration depths (0.7 mm and 0.9 mm) was used to inject saline or viscoelastic materials (Biolon Prime, Healon 5 Pro, and Healon EndoCoat) into the suprachoroidal space (SCS). In cohort 2 (n = 8), an upgraded injector (27-gauge needle and larger-diameter tubing) was evaluated using the 0.9 mm depth. Ultrasound biomicroscopy (UBM) was performed before and after each injection to confirm SCS localization. The primary outcome was successful UBM-verified delivery into the SCS. In cohort 1, injections at 0.7 mm were unsuccessful in all attempts, whereas 0.9 mm enabled correct SCS delivery in all eyes. In cohort 2, successful UBM-confirmed suprachoroidal delivery was achieved in all eight eyes across multiple viscoelastic materials, including sequential and repeat injections that produced a larger, merged suprachoroidal bleb. UBM demonstrated characteristic echogenic appearances for each material. Injection resistance in cohort 2 was consistently mild to moderate. A sclerotomy-free, image-guided, tangential suprachoroidal injection technique using a purpose-built injector is technically feasible in ex vivo porcine eyes. Because this post-mortem model cannot adequately assess hemorrhagic complications, procedural safety and clinical performance require further in vivo evaluation.