OSLI Retina

May/June 2013

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■ C L I N I C A L S C I E N C E ■ Surgery for Retinal Detachment in Patients With Giant Retinal Tear: Etiologies, Management Strategies, and Outcomes Marco A. Gonzalez, MD; Harry W. Flynn Jr., MD; William E. Smiddy, MD; Thomas A. Albini, MD; Paul Tenzel, MD INTRODUCTION BACKGROUND AND OBJECTIVE: To evaluate etiologies, management, and outcomes for patients with giant retinal tears undergoing initial surgery at a single institution. PATIENTS AND METHODS: Noncomparative, retrospective, consecutive case series at a university referral center including 79 eyes of 77 patients. RESULTS: Blunt trauma constituted 22% of cases. All patients underwent pars plana vitrectomy with gas or silicone oil tamponade. Eighty-five percent (67 eyes) underwent an encircling scleral buckle. Perfluorocarbon liquids were used in 71% (61 eyes). Eighteen percent (14 eyes) underwent reoperation for recurrent retinal detachment. Ninetytwo percent (73 eyes) achieved anatomic success with one or more surgical procedures. Visual acuity at last follow-up was at least 20/400 in 84.9% of patients (28 of 33) with 3 clock hours compared to 65.2% (30 of 46) with tears greater than 3 clock hours. CONCLUSION: Patients with giant retinal tear undergoing surgery achieved high rates of anatomic success, but re-operations were frequent. Better visual outcomes were associated with smaller circumferential dimensions in the giant retinal tears. [Ophthalmic Surg Lasers Imaging Retina. 2013;44:232-237.] A giant retinal tear is defined as a contiguous fullthickness retinal break that extends at least 3 clock hours circumferentially in the presence of a posteriorly detached vitreous.1 This is differentiated from a retinal dialysis, in which there is retinal disinsertion at the ora serrata in the absence of a posterior vitreous detachment.2 Giant retinal tears are uncommon entities, with a reported incidence of 0.094 per 100,000 of the general population per year.1 In early reports, the majority of giant retinal tears were described as idiopathic, but other identifiable etiologies included trauma, excessive cryotherapy, or photocoagulation.3 More recent reports indicate a range of causes including genetic and iatrogenic.4,5 Management of retinal detachments associated with giant retinal tears has varied over the past 5 decades. In the 1970s and 1980s, management options included head movements to unfold the retinal tear, fluid-gas exchange with the patient in the prone position, manipulation of the retinal flap using an intraocular balloon, retinal microincarceration, tissue adhesives, sodium hyaluronate, and retinal tacks, screws, and sutures.6-7 More contemporary management options have evolved into vitreoretinal surgery using wide-field viewing and perfluorocarbon liquids.8–13 The current study represents a large noncomparative case series of patients with giant retinal tear–associated retinal detachments undergoing primary management at a university referral center. The etiologies, surgical techniques, and outcomes are reported. From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Florida. Originally submitted November 18, 2012. Accepted for publication March 20, 2013. Supported in part by Research to Prevent Blindness. The supporting source had no role in the study design, collection, analysis, and interpretation of data; writing the report; or the decision to submit the report for publication. Harry W. Flynn Jr., MD, has financial relations with Santen, Almiera, and Pfizer. The remaining authors have no financial or proprietary interest in any of the material presented herein. Address correspondence to Marco A. Gonzalez, MD, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL 33136; 305-326-6000; Fax: 305-326-6114; Email: mgonzalez6@med.miami.edu. doi: 10.3928/23258160-20130503-04 232 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina

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