Purpose:

To investigate the anatomic and visual outcomes of pars plana vitrectomy in patients with rhegmatogenous retinal detachment (RRD) associated with giant tear. Associated procedures to vitrectomy were evaluated.

Background:

The incidence of retinal giant tear in RRD is very low. It represents 0.5% of all retinal detachments. The recurrence of RRD with gian tears is essentially due to the difficulties in re-attaching the posterior edge of the giant tear or to the development of proliferative vitreoretinopathy.

Methods & Results:

We included twenty nine eyes of twenty eight patients successively treated between September 1, 2007 and august 31, 2015 at the Retina Anjou Center. Surgery consisted of pars plana vitrectomy, injection of perfluorocarbon liquid, laser retinopexy, and use of silicone oil or gas endotamponade. The placement of an encircling scleral buckle was not systemically employed in all cases. We evaluated anatomical and functional outcomes of this surgery. Prognostic factors for success were also analyzed. Initially, the mean age of these patients was 49 years (range, 21-96 years). 53% of eyes were phakic, 43% pseudophakic and 4% aphakic. 20% of eyes had a history of ocular trauma and 24 % of eyes were highly myopic. Two patients had a Sticklers syndrome. Mean initial visual acuity was 20/250. At the first retinal detachment surgery, 52 % of eyes had an encircling scleral buckle, 62 % gas endotamponade (C2F6) and 38 % silicone oil. During a mean follow up of 29 months (range,1-127 months), 14 eyes (50%) developed re-detachment and additional operations were performed in all eyes. Lensectomy was performed on 35% of eyes after the first retinal detachment surgery. At final visit, 26 eyes (89.6%) remained attached with visual acuity 20/63 or better in 14 eyes (48%).

Conclusion:

Management of RRD associated with giant tear by vitrectomy has good final anatomic outcome (89.6% of reattachment). However, 50 % of eyes needed more than one procedure to reattach the retina. The use of gas endotamponade at the first procedure seems to be associated with a higher rate of re-detachment. Finally, the effectiveness of systematic placement of an encircling scleral buckle at the first procedure was not demonstrated.

Contact Details:

Email: mounir.benzerroug@gmail.com
Cell Phone: +33664396329

Mounir Benzerroug