A Critical Analysis of Postoperative Outcomes in Rhegmatogenous Retinal Detachment Associated with Giant Tears: A Consecutive, Multicenter Study

Abstract

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.

Long-term postoperative perfusion status in giant retinal tears: a case report

“…The three patients who ful lled the following criteria were included in the surgical cohort, which included: age ≥ 18 years, having GRT-associated RRD, evidence of PVR grade B or less, retinal attachment at the last follow-up examination visit, absence of intraocular silicone oil in the last follow-up visit, at least six months of follow-up, and a well-documented long-term structural, functional, and perfusional ndings of the macula during follow-up visits [18].…”

“…Other exclusion criteria included the presence of intraocular silicone oil during the nal evaluation, PVR (posterior or anterior) with recurrent RRD, and presence of active glaucoma. Additionally, patients who could not maintain the follow up procedures and were operated in other than the included institution and with severe complications (e.g., endophthalmitis, recurrent disease, complicated severe PVR RRD, and refractory corneal opacities) were also excluded [18].…”

“…A detailed eye examination was carried out in all included participants, which included preoperative evaluations such as visual acuities, slit-lamp examination, fundoscopy, and indirect ophthalmoscopy. The assessment protocols used in these cases have been reported previously [18]. In brief, cross-sectional images of the macular region were acquired along the horizontal plane through the foveal center using Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany) or, in some cases, SD-OCT (RTVue-XR platform SD-OCT, Optovue Inc., Fremont, CA, USA), and the axial lengths were measured using partial coherence laser interferometry (Zeiss IOL Master 700; Carl Zeiss Meditec AG, Oberkochen, Germany).…”

“…Surgical technique performed in these patients was described in detail previously [18]. In brief, standard 25-gauge 3-port pars plana vitrectomy (Alcon Constellation Vision System, Alcon Labs, Fort Worth, TX, USA) was performed using a contact wide-angle viewing precorneal lens system (ROLS reinverted system Volk Medilex, Miami, FL, USA) or the Wide-Angle Viewing System (WAVS) with the resight non-contact lens (Carl Zeiss Meditec AG, Jena Germany).…”

“…In addition to central vitrectomy, we use diluted triamcinolone acetonide adjuvant (Kenalog 40 mg/mL; Bristol-Myers Squibb, New York, NY, USA) to better visualize the vitreous face, vitreous base, and its posterior border, and perform a removal of the cortical face from the surface of the retina using a silicone-tipped cannula with active suction prior to per uorocarbon liquid (PFCL) infusion and reattachment of the retina. A subretinal uid (SRF) endodrainage was performed as described previously [18]. In brief, endodrainage was done slowly by implementing a rst-step air-to-uid exchange over the edge of the GRT to avoid posterior retinal slippage before proceeding to a second air-uid exchange and continuing with SRF drainage.…”