Introduction:

Retinal detachments with giant retinal tears pose a significant challenge, even to the most experienced vitreoretinal specialists. The extent of the primary lesion complicates management and tamponade choices, carrying the risk of the flap folding over post-operatively and re-detaching the retina. The authors present one case of a macula-on retinal detachment with multiple giant tears.

Case report:

The authors present the case of a 55-year old male patient, presenting with an acute vision loss over the past 3 days in the left-eye. Examination revealed an hemovitreous that made posterior examination impossible, but ultrassound examination confirmed a superior and inferior retinal detachment, with the macula possibly still attached. The next day, the patient was submitted to a 23-gauge vitrectomy. The authors then confirmed a macula-on retinal detachment, associated with two giant retinal tears, one superior and another inferior, as well as another superior large retinal tear. With the help of PFC liquid, the surgeon then proceeded to cut the rolled tear borders to better attach the retina, performed a peripheral retinectomy, followed by 360o endolaser and silicon oil/PFCL direct exchange. Unfortunately, even under silicone oil, the retinal borders of the giant tears were not attaching at the end of the procedure after multiple attempts. The authors chose to end the surgery nonetheless and prescribe face down positioning in the post-op period. The next day, the retina was completely attached and no folding of the tear borders was found. Conclusions: when present, giant retinal tears mandate a very careful approach to the retinal detachment, requiring vitrectomy. The risk of post-op flap slipping should be avoided with careful rolled border cutting and peripheral retinectomy, laser barrage, effective tamponade and disciplined head positioning to maximize the result. In our case, a still attached macula guaranteed a very good visual prognosis.

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David da Fonseca Martins