The authors report an eight year retrospective case series study of 30 eyes of 29 patients with who underwent a giant retinal tear-related retinal detachment repair. M: F ratio was 23:6. Right to left eye ratio was 16:14. The mean age was 43.7 years (range 10–72). Twenty-seven patients were Caucasian, one Asian and one African with known sickle cell retinopathy. The 30 eyes included 20 idiopathic GRTs, three presumed traumatic GRTs, and three iatrogenic post PPV GRTs. Seven eyes were highly myopic. One patient had features of Stickler’s syndrome. Twenty-one eyes were phakic, eight were pseudophakic, and one eye was aphakic. Postoperative follow-up period ranged from nine to 55 months with mean 26.8 months. Mean pre-operative BCVA was 1.1 LogMAR (range 0-3.5). Fourteen eyes had macula-on and 16 eyes were macula-off. The mean size of the GRTs was 150° (range 90–270) with 46% from >180. The tears were wholly or partially located inferiorly in five of the cases. Four eyes had PVR grade C pre-operatively. SF6 20% was used in 13.3% (four) of eyes, C2F6 12% in 3.3% of eyes (one), C3F8 14% was used in 56.6% (17) eyes, and 23.3% (seven) eyes had SO. Intraoperative findings included retinal reattachment in all 30 eyes. Re-detachment occurred in four eyes in the first three months; three had PVR and one eye had new tears. A total of four eyes underwent further surgery, three with repeated vitrectomy and one with combined SB and PPV. At final follow-up, the anatomic success rate was 27 of 30 eyes (90%) with flat retina and no tamponade and the remainder three eyes had SO in situ. In terms of visual function, 70% had an overall improvement in vision, 41% improved by two lines, and 35% had 6/12 vision or better. Cataract developed in 50% of the eyes during the follow-up. Anterior uveitis developed in six eyes which settled with topical steroids. One eye developed glaucoma which was controlled medically. Conventional three-port pars plana 20 or 23G vitrectomy (PPV) under taken perfluoro-n-octane PFO injected unroll the folded retina. Cryotherapy and endo-photocoagulation was applied around the tear and to the vitreous base 360° in all eyes. PFO was left in the eye and patients were asked to position according to the location of their GRT. A second-stage surgery to remove the PFO was performed after a week with PFO/BSS fluid exchange followed by internal search by indentation, to examine retinal periphery. Following this, air–fluid exchange was performed with subsequent air/gas (either SF6, C2F6, or C3F8) or SO exchange. During the second stage, cryotherapy and / or endolaser photocoagulation was used for further re-enforcement of the retina if deemed necessary. This case series offers an alternative technique in the management of GRT, which appears safe and effective. In the experience of the authors, this technique has a shorter learning curve and is technically easier to perform. In addition, the need for SO as a primary tamponade in some eyes is reduced. Drawbacks are the multiple surgeries in every patient and PFO-related complications including raised IOP, progression of cataract, and intraocular inflammation. 

Management of giant retinal tears with vitrectomy and perfluorocarbon liquid postoperatively as a short-term tamponade.
Mikhail MA, Mangioris G, Best RM, et al.
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Saruban Pasu

Moorfields Eye Hospital, London, UK.

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