Anatomical and visual outcome of vitrectomy for giant retinal tear detachment with proliferative vitreoretinopathy: A retrospective, consecutive case series

Abstract

Aim: To report the anatomical and visual outcome of giant retinal tear (GRT) associated retinal detachment (RD) with advanced proliferative vitreoretinopathy (PVR) and determine the effect of presenting clinical and surgical variables Method: Retrospective, non-comparative, consecutive, interventional case series of vitreoretinal surgeries performed in a private tertiary eye unit. Patient demographics, preoperative, and intra-operative variables were assessed and analyzed. Inclusion: Eyes which had surgery for previously unoperated GRT RD with PVR and had > 3 months of follow up. Exclusion: Other primary and secondary forms of RD with no GRT. Results: Thirty-six eyes of 36 patients were evaluated. Male: female ratio = 5:1. Mean age of 45.53 ± 13.2 years (range 12 - 65 years). Left eye, twenty-three eyes (63.9%). Rate of advanced PVR C and D was 83%, four quadrant (total RD) 55.6%, macula detachment 91.7%, giant tear size was 90 to 180 degree and > 180 degree in 55.6% and 33.3% respectively. Single surgery attachment rate was 41.7% and final attachment after a second surgery was 86.1%. Visual outcome was CF or better in twenty-three eyes (63.9%). Recurrent RD in 58.3% was due to postoperative PVR. Gender, age, laterality, PVR grade, giant tear size, quadrants affected by RD had no impact on anatomical outcome (p> 0.05). Significantly, scleral buckle (SB) use did not reduce rate of recurrent RD and had no significant effect on anatomical outcome (p > 0.05). Conclusion: GRT RDs have a higher rate of PVR compared to more commonly encountered RRD. When treating GRT RD with advanced PVR, meticulous membrane removal should be accomplished using vital dyes to aid visualization. This will reduce recurrence of postoperative PVR. Pre-, intra- and post-operative factors, including use of a SB did not affect single surgery success. Visual improvement is limited by the occurrence of PVR.