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John Pitcher, Mohammed Khan, Philip Storey, Michael Dollin, Carl Regillo, Sunir Garg; Giant Retinal Tear Detachments: Surgical Strategies and Outcomes. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2864. doi: https://doi.org/.
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The annual incidence of giant retinal tears (GRTs) is estimated at 0.114 cases per 100,000, and they make up 2.5%-8.3% of all cases of rhegmatogenous retinal detachment (RRD). Their relative rarity is fortunate, as they are generally more surgically challenging and carry a 20-30% risk of primary repair failure. Several small studies have retrospectively analyzed operative factors and their effect on outcomes, but a consensus technique remains unclear. The primary goal of this review of the surgical management of GRTs is to determine whether: a. small-incision (23-gauge) pars plana vitrectomy (PPV) outcomes are similar to historical controls (20-gauge) b. placing a scleral buckle (SB) is necessary for higher rates of anatomic success c. silicone oil intravitreal tamponade is superior to gas d. 360 degree laser photocoagulation is useful in preventing redetachment.
This study is a retrospective, observational, consecutive case series of all patients diagnosed with giant retinal tear with retinal detachment who were treated by the Retina Service of The Wills Eye Institute, Philadelphia, PA. The billing records of all patients seen at MAR between January 1, 2007 and January 1, 2012 were reviewed for the ICD-9 code for giant retinal tear (361.03). Patient records were reviewed for age, gender, affected eye, pre-operative best corrected visual acuity (BCVA), complete ophthalmic examination of both eyes, details of surgical technique, and BCVA and retinal examination at 1, 3, 6, and 12 months and final follow-up.
Fifteen eyes were identified. Mean age was 56 years and 6 eyes (40%) were pseudophakic. Average pre-operative logMar visual acuity (LMVA) was 1.32 (20/417). All patients underwent 23-gauge PPV with intravitreal tamponade (11 C3F8, 4 silicone oil). Scleral buckle (SB) was placed in 10 eyes (67%). Nine eyes received 360° laser retinopexy. Average length of follow-up was 20 months (range 3-90), and average best logMar VA was 0.69 (20/98). One redetachment (1/15, 6.7%) occurred in a patient treated with PPV/C3F8/360° laser.
GRT associated RRD can be managed successfully by different surgical techniques. In this limited case series, the outcomes of repair with small-incision PPV do not appear inferior to historical controls. Larger studies are warranted to determine the optimal surgical strategy.
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