Cohesive Viscoelastic-Assisted Vitrectomy for Severe Ocular Trauma: A Novel Retinal Reattachment Approach

Abstract Background Severe ocular trauma often leads to highly detached retinas with limited reattachment success, risking irreversible atrophy. This study describes the novel use of cohesive viscoelastic during pars plana vitrectomy (PPV) to improve retinal reattachment in complex cases with rotated, shattered, or severely wrinkled retinas Methods We present a detailed, stepwise surgical technique for cohesive viscoelastic-assisted retinal repositioning of severely injured retinas in different conditions. After vitrectomy, cohesive viscoelastic (0.1–0.3 mL) was injected directly into vitreous, targeting optic disc or shattered retinal pieces to exert multidirectional hydraulic pressure, in order to stabilize and flatten detached tissues. We illustrate this technique with a preliminary case series of 12 eyes (OTS categories 1 and 2, all presenting proliferative vitreoretinopathy grade D2 or D3). Results Cohesive viscoelastic facilitated retinal reattachment. Firstly, dislocated retinas that rotated after injury smoothly return to previous place with pressure imposed by cohesive viscoelastic. In addition, with viscoelastic, crimple and shattered retinal pieces can be flattened to filled in original hole. Moreover, cohesive viscoelastic filled up and smoothed ravine of retina, exposing epiretinal or internal limiting membranes for peeling. Complete anatomical reattachment was achieved in all eyes at 3-month follow-up. No viscoelastic-related adverse events were observed. Postoperative visual acuity showed a trend toward improvement compared to preoperative status. Conclusions Cohesive viscoelastic-assisted vitrectomy is a safe and feasible surgical technique that offers unique mechanical advantages for retinal reattachment in complex traumatic injuries. It provides a promising advance for previously untreatable cases. The trial registration number: NCT07038668; registered on 07/03/2025 (retrospectively registered)