Outcome of surgery in patients with giant retinal tear: 10 years experience

Abstract

PurposeTo present our experience with the surgery in retinal detachment (RD) associated with giant retinal tear (GRT) over 10 years in a tertiary referral hospital.Patients and MethodsIn this retrospective study, the charts of all patients with the diagnosis of RD associated with GRT who underwent surgery from 2005 to 2015 at Rassoul Akram Hospital were reviewed. Exclusion criteria were concomitant presence of diabetic retinopathy, and uveitis. All patients had to have at least 3 months of follow up. The success rate and factors associated with repeated surgery were determined.ResultsSixty two eyes of 61 patients including 51 males and 10 females were assessed. Proliferative vitreoretinopathy (PVR) was present in 14 (22.6%) of eyes. Pars plana vitrectomy (PPV) alone was performed in 44 eye (71.0%) and simultaneous vitrectomy and phacoemulsification surgery was performed in 18 eyes (29.0%). An encircling episcleral band was placed in 7 eyes (11.3%). Anatomic success after one vitrectomy procedure was achieved in 45 eyes (72.58%) and ultimately in 61 eyes (98.4%) at last follow up. Seventeen eyes needed repeated PPV due to redetachment associated with PVR in the follow up period. The rate of repeated PPV was significantly higher in eyes with PVR at baseline and surgery with encircling episcleral band. Trauma, extension of tear, age, and lens status had no significant effect on the rate of repeated PPV.ConclusionsOur study shows that the high surgical success can be achieved in patients with RD associated with GRT with single or multiple surgeries.

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

“…This percentage falls within the upper end of published rates in the modern literature, which reports 16% to 64% achieving 20/40 or better at last follow-up. 1 , 3 , 10–13 , 23 , 25 …”

“…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.…”

“…This percentage falls within the upper end of published rates in the modern literature, which reports 16% to 64% achieving 20/40 or better at last follow-up. 1,3,[10][11][12][13]23,25 While there have been large, multicenter, randomized controlled clinical studies 14 on the treatment of primary RD, the surgical complexity inherent to managing GRTs and the rarity of the condition have not allowed for such trials to be conducted on different approaches to its repair. Instead, a growing number of clinical series, both retrospective and prospective, have demonstrated mixed outcomes in the management of GRTs (Table 1).…”

Vitrectomy with silicone oil tamponade for retinal detachment associated with giant retinal tears: Favourable outcomes without adjuvant scleral buckling

“…Recently, Ghasemi Falavarjani et al. () reported a final success rate of 98% and final VA better than 20/40 in 16% of GRT‐associated detachments managed with silicone oil. Grade C PVR was present in 23% of the eyes, lensectomy was performed in 29% of cases, and at the end of follow‐up, in 34% of the eyes, silicone oil had not been removed.…”

Demography, clinical profile and surgical outcomes of paediatric giant retinal tear related retinal detachments

“…Most of the adult cases of GRT are idiopathic and have a high male preponderance [2]. Other risk factors include trauma, high myopia [3], Marfan's syndrome [4], Stickler syndrome, hereditary vitreoretinopathies [5], and acute retinal necrosis [6].…”