Management of giant retinal tears with vitrectomy, internal tamponade, and peripheral 360 degrees retinal photocoagulation.

Abstract

To determine the effectiveness of vitrectomy, internal tamponade, and peripheral 360 degrees retinal photocoagulation in the management of giant retinal tears (GRTs). Eighteen eyes of 18 consecutive patients with GRTs were operated on at Jules Gonin Eye Hospital between 1992 and 1999. None of them had previous vitreoretinal surgery. Eyes in the series underwent pars plana vitrectomy, perfluorocarbon liquid and silicone oil (17 eyes) or gas (one eye) exchange, and retinopexy. Retinopexy was applied to the edges of the tear using photocoagulation, and it was extended over 360 degrees to the peripheral attached retina. No scleral buckle was placed, even if proliferative vitreoretinopathy (PVR) was present. The GRT was 180 degrees or greater in seven eyes and 90 degrees to 180 degrees in 11 eyes. The lower edge of the GRT was located in an inferior quadrant in 15 eyes. PVR was grade A in seven eyes, grade B in eight eyes, and grade C in three eyes. In the last three eyes, PVR was anterior (C-A9, Patient 4) and posterior (C-P6 subretinal, Patient 11; C-P3, Patient 13). In 16 (88.8%) of the 18 eyes, the retina was successfully reattached after surgery, and silicone oil was removed after a mean period of 7.7 weeks. In the other two eyes, the retina remained detached or redetached despite the silicon oil tamponade. One of these two eyes underwent three further surgeries, but the retina did not reattach. The other eye was successfully reoperated on with an encircling and radial scleral buckle, and silicone oil was removed later. At the end of the follow-up, the retina was attached in 17 (94.4%) of the 18 eyes. The mean follow-up was 28.6 months (range, 4.5-73 months). The success rate of management of GRTs with vitrectomy, internal tamponade, and peripheral 360 degrees photocoagulation of the retina without scleral buckle is high. Photocoagulation of the peripheral retina over 360 degrees appears to decrease the risk of secondary peripheral retinal tears.