Giant Retinal Tear Detachment: Clinical presentation and Treatment Outcomes in 396 patients.

Abstract

To study etiology, clinical presentation, anatomical and functional outcomes of patients with giant retinal tear detachment (GRTD) at a tertiary eye institute. Retrospective, consecutive case series of 396 patients (396 eyes) who underwent surgery were reviewed. Factors affecting the final anatomical and functional success were determined. Mean age was 37 years (range; 1-79 years) and 86% (n=339) of the subjects were male. Trauma (21%) and high myopia (11%) were predisposing risk factors. Two hundred and seventy-seven eyes (70%) had giant retinal tear configuration of >180o and <270o, associated with partial retinal detachment (RD) in 282 (71%) eyes and macular detachment in 262 (66%) eyes. Primary surgery included pars plana vitrectomy (PPV) (n=240, 61%), PPV with encirclage band (n=152, 38%) or scleral buckle (n=4, 1%). The mean follow-up duration was 15 months (median, 8.4 months; range, 3-83 months). Anatomical success after initial surgery was 64% (255 eyes), which improved to 78% (308 eyes) after undergoing a second vitreoretinal procedure for recurrent RD (53 eyes). Median visual acuity improved from 20/1500 preoperatively to 20/400 at final follow-up (p= 0.01), and 15% of eyes achieved postoperative visual acuity of 20/60 or better. Factors associated with poor anatomical success included age < 16 years (p=0.005), and presenting visual acuity 20/400 or less (p=0.001). Trauma and myopia constituted the major risk factors for GRTD in our series. Surgery for GRTD managed with PPV with or without encirclage band and silicone oil tamponade had good anatomic and favourable visual outcomes at last follow-up.