Managing Giant Retinal Tears 2 Cases Report


ABSTRACT

Introduction:

Retinal detachments with giant retinal tears (GRT) 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 two cases of a retinal detachment with giant tears.

Case report:

First case – A 55-year old male patient presented with an acute vision loss over the past 3 days in the left-eye. Examination revealed a vitreous haemorrhage that made posterior examination impossible, but ultrasound 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. We 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 perfluorocarbon liquid (PFCL), we unfolded the posterior flap of the GRT, and cut the residual rolled borders, to better attach the retina. We performed a retinectomy of the anterior flap of the tear. Then, we performed 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 at tempts. 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. Second case – A 66-year old male presented with acute vision loss on the left eye. Fundus examination showed a rhegmatogenous retinal detachment with macula-off and a giant temporal retinal tear. We performed cataract surgery followed by 23-gauge vitrectomy. We used the same technique described above, but this time, the retinal flaps of the giant tear were re-attached at the end of the surgery, after PFCL/silicone oil direct exchange.

Conclusion:

When present, giant retinal tears mandate a very careful approach to the retinal detachment, requiring vitrectomy. The risk of post-operative posterior retinal slippage should be avoided with careful rolled border cutting, laser barrage, careful PFCL/air or silicone oil exchange and effective tamponade. Disciplined head positioning after the procedure is also critical to maximize the result.


CONTACT DETAILS

 

David Martins
Setubal, Portugal
Email : drdavidmartins@hotmail.com
Cell Phone: +351964029156
Work Phone: +351265549000