GIANT RETINAL TEAR DETACHMENT Clinical Presentation and Treatment Outcomes in 396 Patients

Purpose:To study etiology, clinical presentation, anatomical, and functional outcomes of patients with giant retinal tear detachment at a tertiary eye institute.Methods:Retrospective, consecutive case series of 396 patients (396 eyes) who underwent surgery were reviewed. Factors affecting the final anatomical and functional success were determined.Results:Mean age was 37 years (range; 1-79 years), and 86% (n = 339) of the subjects were men. Trauma (21%) and high myopia (11%) were predisposing risk factors. Two hundred and seventy-seven eyes (70%) had giant retinal tear configuration of >180 degrees and <270 degrees, associated with partial retinal detachment in 282 (71%) eyes and macular detachment in 262 (66%) eyes. Primary surgery included pars plana vitrectomy (n = 240, 61%), pars plana vitrectomy with encirclage band (n = 152, 38%), or scleral buckle (n = 4, 1%). The mean follow-up duration was 15 months (median, 8.4 months; range, 3-83 months). Anatomical success after initial surgery was 64% (255 eyes), which improved to 78% (308 eyes) after undergoing a second vitreoretinal procedure for recurrent retinal detachment (53 eyes). Median visual acuity improved from 20/1,500 preoperatively to 20/400 at final follow-up (P= 0.01), and 15% of eyes achieved postoperative visual acuity of 20/60 or better. Factors associated with poor anatomical success included age <16 years (P = 0.005) and presenting visual acuity 20/400 or less (P = 0.001).Conclusion:Trauma and myopia constituted the major risk factors for giant retinal tear detachment in our series. Surgery for giant retinal tear detachment managed with pars plana vitrectomy with or without encirclage band and silicone oil tamponade had good anatomical and favorable visual outcomes at last follow-up.