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Mounir Benzerroug, Badreddine Chanaoui, Olivier Genevois, Gerard Brasseur, Solange Milazzo, Marc Muraine; Prognosis Factors Of Rhegmatogenous Retinal Detachments Associated With Giant Tear. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5809.
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The incidence of retinal giant tear in RRD is very low. It represents 0.5% of all retinal detachments. The recurrence of this type of RRD is essentially due to the difficulties re-applying the posterior edge of the giant tear or to the development of proliferative vitreoretinopathy.To investigate the anatomic and visual outcomes of vitrectomy in patients with rhegmatogenous retinal detachment (RRD) associated with giant tear. Associated procedures to vitrectomy were evaluated.
We included twenty nine eyes of twenty eight patients successively treated between September 1, 2001 and august 31, 2010 at a tertiary referral hospital. Treatment in most was managed by pars plana vitrectomy, injection of perfluorocarbon liquid, laser retinopexy, and use of silicone oil or gas endotamponade. The placement of an encircling scleral buckle wasn’t systematic. We evaluated anatomical and functional outcomes of this surgery. Prognosis factors of success were analyzed.
Initially, the mean age of these patients was 49 years (range, 21-96 years). 53% of eyes were phakic, 43% pseudophakic and 4% aphakic. 20% of eyes had a history of ocular trauma and 24 % of eyes were highly myopic. Two patients had a Stickler’s syndrome. The mean initial visual acuity was 20/250. At the first retinal detachment surgery, 52 % of eyes had an encircling scleral buckle, 62 % gas endotamponade (C2F6) and 38 % silicone oil endotamponade. During a mean follow up of 29 months (range,1-127 months), 14 eyes (50%) developed re-detachment and additional operations were performed in all eyes. Lensectomy was performed on 35% of eyes after the first retinal detachment surgery. At final visit, 26 eyes (89.6%) had retinas that remained attached with visual acuity 20/63 or better in 14 eyes (48%).
Management of RRD associated with giant tear by vitrectomy has good final anatomic outcome (89.6% of reattachment). However, 50 % of eyes needed more than one procedure to reattach the retina. The use of gas endotamponade at the first procedure seems to be associated to a higher rate of re-detachment. Finally, the effectiveness of systematic placement of an encircling scleral buckle at the first procedure wasn’t demonstrated.
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