Background: Currently there remains controversy in the surgical management of rhegmatogenous retinal detachment (RRD) due to giant retinal tears (GRTs), a potentially blinding condition. To clarify which surgical technique is better depending on the origin and magnitude of the giant tear this study aimed to analyze the anatomical and functional outcomes. To analyze trans- and postoperative surgical complications, we used long-term final postoperative structural, optical coherence tomography (OCT) and correlated the results with the final postoperative best-corrected visual acuity (BCVA) in three different groups of eyes.Methods: Seventy-six consecutive eyes of 66 patients from three participant institutions were recruited and classified according to the degree of GRT-associated RRD extension as follows: group 1, 42 eyes with GRT-associated RRD extension < 180°; group 2, 23 eyes with GRT-associated RRD extension = 180°–270°; and group 3, 11 eyes with GRT-associated RRD extension > 270°. Structural and functional outcomes were compared across groups.Results: Of the 76 eyes analyzed, 63 were phakic, and 13 were pseudophakic. The mean age of the patients was 43.0 ±13.0 years (range, 19–76 years); 36 females, and 40 males. The mean preoperative time for GRT surgery was 1.8 weeks, the mean preoperative and postoperative BCVA was 1.87 logMAR and 0.35 logMAR, respectively (p<0.05), and the mean postoperative follow-up was 28.1 months. Five patients (6.57%) had bilateral GRT-associated RRD, 61 patients (80.26%) had a monocular condition, and 21 eyes (27.63%) had a BCVA ≥20/40. Proliferative vitreoretinopathy resulted in multiple surgeries in 31.57% of the eyes. Postoperative OCT yielded abnormal retinal thickness in all groups, ellipsoid band disruptions, and external limiting line discontinuities in all groups, predominantly in macula-off GRTs requiring multiple surgeries. Conclusions: Multiple structural alterations in spectral-domain OCT biomarkers were observed. Eyes that developed secondary epiretinal membrane (ERM) proliferation showed significantly improved BCVA after proliferation, and the internal limiting membrane was removed. This study presents the severe consequences of macular structure and function. The structural findings correlated with the BCVA allow us to conclude severe consequences of the macular structure and that, despite a fully reattached retina without ERM proliferation, GRTs-associated RRD has a guarded functional prognosis.

Limited data are available on the long-term perfusional status of patients who have undergone successful surgery for giant retinal tear (GRT) macula-off rhegmatogenous retinal detachment (RRD). This study examines the long-term outcomes in eyes treated for varying degrees of GRT-associated RRD extensions and compared them with two control groups. Twenty-five emmetropic normal eyes (control emmetropic), 20 healthy myopic eyes (control myopic), and 33 eyes surgically treated for GRT (surgical) were included in this study for a comparison of long-term structural, perfusional, and functional outcomes. The surgical eyes were categorized based on degree of GRT-associated RRD extension: 19 eyes with GRT-associated RRD extension <180° and 14 eyes with extension >180°. The eyes were further separated by whether they required placement of a complementary 360° scleral buckle. The mean age of the patients was 55.18 years and the mean pre-operative evolution of GRT was 2.36 weeks. The average pre- and post-operative best-corrected visual acuities (BCVAs) were 1.90 logMAR and 0.59 logMAR, respectively, which were different with statistical significance. Proliferative vitreoretinopathy resulted in multiple surgeries in nine eyes (27.3%). Long-term post-operative optical coherence tomography (OCT) showed 11 eyes (33.3%) with abnormal foveal contour, 13 eyes (39.4%) with ellipsoid zone disruption, two eyes with dissociated optic nerve fiber layer defects, and 15 eyes (45.4%) with external limiting membrane line discontinuities. OCT angiography yielded abnormal perfusion indices in the surgically treated eyes (P < 0.0001). Correlation analysis found that post-surgical BCVA was negatively correlated with superficial foveal avascular zone area, superficial parafoveal vessel density, and central subfoveal thickness, while positively correlated with choriocapillaris flow area. Our data showed that eyes with GRT-associated RRD have multiple structural alterations in spectral-domain OCT biomarkers that are correlated with visual outcomes. Despite successful retina reattachment without proliferation, management of GRT-associated RRD remains challenging.

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Background: There is abundant and even confusing information in the available literature concerning the role of internal limiting membrane (ILM) removal in macular conditions secondary to non-complicated macula-off rhegmatogenous retinal detachment (RRD) repair. This retrospective, multicenter, long-term study aimed to analyze the incidence of epiretinal membrane (ERM) proliferation and other surgical complications and to compare the postoperative microstructural and multimodal imaging findings and correlate them with the final postoperative best-corrected visual acuity (BCVA) in selected eyes.