Giant retinal tears: clinical features and outcomes of vitreoretinal surgery at a university teaching hospital (2011–2017)

Abstract

PurposeThe purpose of this study was to report clinical features and outcomes in patients with giant retinal tears (GRTs) undergoing vitreoretinal surgery and to compare data from this contemporary series to a previous study from the same institution.Materials and methodsA retrospective, interventional, consecutive case series was conducted for all patients diagnosed with GRTs who underwent vitreoretinal surgery between January 2011 and August 2017. Intraoperative data including the use of scleral buckling, perfluorocarbon liquid, and intraocular tamponade were collected and compared according to GRT size. These parameters, along with postoperative anatomic success and best-corrected visual acuity (BCVA), were compared with the previous series.ResultsThe study included 80 eyes of 79 patients with a presentation of retinal detachment with a GRT. Management approach for repair of GRT-associated retinal detachments included scleral buckle (SB) alone (three eyes, 4%), pars plana vitrectomy (PPV) (16 eyes, 20%), and combined SB/PPV (61 eyes, 76%). Perfluorocarbon liquids were used in 60/77 eyes (78%) undergoing PPV, and silicone oil was used in 54/77 eyes (70%). Single surgery success rate was in 69/80 eyes (86%). Eyes managed with SB (including SB alone and SB/PPV) or PPV without SB had similar rates of recurrent retinal detachment (16% vs 6%; P=0.33). Anatomic success was achieved in 76/80 eyes (95%) with one or more surgical procedures, and 54/80 eyes (68%) achieved postoperative BCVA of ≥20/400.ConclusionsIn the current series, repairs of retinal detachment due to GRTs were most commonly managed with combined PPV/SB and perfluorocarbon liquid, resulting in reasonably generally favorable anatomic and visual outcomes.

Contemporary Management of Complex and Non-Complex Rhegmatogenous Retinal Detachment Due to Giant Retinal Tears

“…While a small randomized trial of 47 GRTs found no difference in 5-year complications, 29 anatomic reattachment, and visual outcomes between tamponade with silicone oil or C 3 F 8 gas, silicone oil is still the tamponade of choice at most centers worldwide ( Table 1 ). 3 , 11–13 , 22–24 , 29 Similar to previous studies, we found comparable anatomic outcomes with the use of gas (SSAS=69%) and oil tamponade (SSAS=56%, P =0.457). 1 , 3 , 10–13 , 22–24 , 29 , 30 Interestingly, only 9 (19%) eyes in this current series had oil tamponade at primary repair, of whom 2 were pediatric patients who could not position.…”

“…Furthermore, in the other contemporary published series that did not exclude these cases, GRTs were attributed to trauma in only 16.1% to 35.3% of the studied population, lower than the 42% of GRTs in the present study associated with ocular trauma. 3 , 11 , 13 , 24 ,25 Secondly, four subjects (8%) were under the age of 12, making it difficult to directly compare our pediatric GRTs to other studies in which the exclusion criteria were those under a certain age. 8 , 10 , 21 , 26 Although this study did not have sufficient statistical power to detect a statistically significant difference between pediatric (<12 years) and adult GRT SSAS rates (50% vs 68%), our results are consistent with pediatric RRDs being generally associated with lower anatomic success rates compared to adult cases.…”

<p>Comparison Between Silicone Oil and Gas in Tamponading Giant Retinal Breaks</p>

“…analysis conducted at the Bascom Palmer Eye Institute that found no difference in primary success or final vision between silicone oil and C 3 F 8 tamponade after PPV for GRT. 3 A randomized controlled study conducted by Batman et al demonstrated similar findings. 30 On the other hand, the European Vitreo-retinal Society Retinal Detachment study found that silicone tamponade was associated with more cases of level 2 failure after GRT surgery compared to gas, while level 1 failure rates were similar between both groups.…”

“…2 Pars plana vitrectomy (PPV), with or without adjuvant scleral buckling, is the current standard of care for RRDs secondary to GRTs. 3 The introduction of heavy perfluorocarbon liquids (PFCLs) has facilitated surgical management of GRTs and increased the success rates from 58% to more than 90%. 3,4 Several agents have been used for intraocular tamponade after PPV for GRT, including silicone oil, expansile gases, short or medium-term PFCLs and semifluorinated alkanes.…”

“…3 The introduction of heavy perfluorocarbon liquids (PFCLs) has facilitated surgical management of GRTs and increased the success rates from 58% to more than 90%. 3,4 Several agents have been used for intraocular tamponade after PPV for GRT, including silicone oil, expansile gases, short or medium-term PFCLs and semifluorinated alkanes. 1 To date, silicone oil remains the most frequent choice for endotamponade in such cases.…”