Management of Giant Retinal Tear Detachments.

MariaH Berrocal,LuisA Acaba,MeganL Chenworth

doi:10.4103/2008-322x.200158

Abstract

Giant retinal tears (GRTs) are full-thickness circumferential tears of more than 90 degrees of the retina that are associated with vitreous detachment. They are related to ocular trauma, high myopia, aphakia, pseudophakia, genetic mutations involving collagen and young age. GRTs comprise 1.5% of all rhegmatogenous retinal detachments and the average age of incidence is 42 years. GRTs are more common in males, as 72% of all cases occur in males. The incidence of GRTs in the general population is estimated to be 0.05 per 100,000 individuals. Common techniques used in the management of GRTs include fluid-air exchange, pneumatic retinopexy, scleral buckling, primary vitrectomy with gas or silicone oil tamponade, and combined scleral buckle-vitrectomies. However, management of GRTs poses a great challenge to physicians due to the high risk of intra- and post-operative complications and the many technical difficulties involved. The advent of perfluorocarbon liquids (PFCL) and the use of micro-incisional surgery for the treatment of GRTs has provided new opportunities for the management of GTRs. Today, retinal reattachment can be achieved in 94-100% of cases.

Highlights

Giant retinal tears (GRTs) are defined as full‐thickness circumferential tears of more than 90 degrees of the retina associated with vitreous detachment.[1,2,3]
GRTs can occur spontaneously, they are often associated with a number of conditions; these include ocular trauma, high myopia, aphakia, Correspondenceto: Maria H
The major complications associated with micro‐incisional surgery for GRTs include retinal slippage during perfluorocarbon liquids (PFCL) removal; retinal folds associated with slippage, SB, or high myopia; residual PFCL; cataract progression and recurrent RD with proliferate vitreoretinopathy (PVR).[3,26]

Summary

Introduction

Giant retinal tears (GRTs) are defined as full‐thickness circumferential tears of more than 90 degrees of the retina associated with vitreous detachment.[1,2,3] Their management poses significant challenges due to the many complications and technical difficulties involved. Advantages of small gauge vitrectomy include less trauma, smaller incisions, reduced sclerotomy complications, and shortened surgical times.[23] Challenges of 25‐gauge vitrectomy in the management of giant tears include a slower removal of vitreous, some difficulty reaching the anterior retina and vitreous near the ora serrata, flexible instruments, and a more prolonged aspiration time during the air/ fluid exchange.[24] This last step is crucial to prevent retinal slippage and extra time should be allotted for this maneuver when using smaller gauge instruments.

Results

Conclusion