Management of Giant Retinal Tear Detachments

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Abstract

Giant retinal tears (GRTs) are full-thickness circumferential tears of more than 90 degrees of the retina that are associated with vitreous detachment. They are related to ocular trauma, high myopia, aphakia, pseudophakia, genetic mutations involving collagen and young age. GRTs comprise 1.5% of all rhegmatogenous retinal detachments and the average age of incidence is 42 years. GRTs are more common in males, as 72% of all cases occur in males. The incidence of GRTs in the general population is estimated to be 0.05 per 100,000 individuals. Common techniques used in the management of GRTs include fluid-air exchange, pneumatic retinopexy, scleral buckling, primary vitrectomy with gas or silicone oil tamponade, and combined scleral buckle-vitrectomies. However, management of GRTs poses a great challenge to physicians due to the high risk of intra- and post-operative complications and the many technical difficulties involved. The advent of perfluorocarbon liquids (PFCL) and the use of micro-incisional surgery for the treatment of GRTs has provided new opportunities for the management of GTRs. Today, retinal reattachment can be achieved in 94-100% of cases.

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Low viscosity liquid fluorochemicals in vitreous surgery.

S. Chang (1987)

Low viscosity liquid fluorocarbons have physical properties potentially useful as intraoperative adjuncts during vitreous surgery for complicated retinal detachments. These substances are optically clear, have specific gravity greater than that of water, and interfacila tension properties similar to those of silicone oil. In four patients who had complicated retinal detachments I used perfluorotributylamine and perfluorodecalin during vitreous surgery. Two giant retinal tears were flattened intraoperatively without turning the patient into the prone position. In two patients with severe proliferative vitreoretinopathy, perfluorotributylamine allowed adequate retinal tamponade and avoided a posterior retinotomy for internal drainage of subretinal fluid. Endophotocoagulation was applied.

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Adjuvant 5-fluorouracil and heparin prevents proliferative vitreoretinopathy : Results from a randomized, double-blind, controlled clinical trial.

Riaz H Y Asaria, Peng Khaw, Lawrence H Le … (2001)

To assess the safety and efficacy of adjuvant combination therapy using 5-fluorouracil (5-FU) and low molecular weight heparin (LMWH) for prevention of proliferative vitreoretinopathy (PVR) after vitrectomy and retinal reattachment surgery. Prospective randomized, double-masked, placebo controlled trial. One hundred seventy-four high-risk patients were randomized to receive either 5-FU and LMWH therapy or placebo. Patients were selected from all patients undergoing primary vitrectomy for rhegmatogenous retinal detachment. Results of standard surgery with 5-FU and LMWH therapy or placebo were compared at the 6-month follow-up. Development of postoperative PVR, retinal reattachment at 6 months after surgery, single operation reattachment rate, number of reoperations, and best-corrected visual acuity. There were 87 patients in the 5-FU and LMWH therapy group and 87 in the placebo group. The incidence of postoperative PVR was significantly lower (P = 0.02) in the 5-FU and LMWH therapy compared with the placebo group. In 26.4% (23/87) of the placebo group and in 12.6% (11/87) of the 5-FU and LMWH group, postoperative PVR developed. In the 5-FU and LMWH group, the number of patients undergoing more than one operation was 19.5% (17/87) and the number of reoperations resulting from PVR was 52.9% (9/17). In the placebo group, the number of patients undergoing more than one operation was 25.3% (22/87) and the number of reoperations resulting from PVR was 72.7% (16/22). The difference in visual acuity was not statistically different in the two treatment groups, although those patients in whom postoperative PVR developed tended to have poorer vision (P < 0.0001). There were no differences in complication rates between the two groups. There is a significant reduction in the incidence of postoperative PVR in patients receiving the 5-FU and LMWH therapy and in the reoperation rate resulting from PVR. This trial shows that incidence of PVR can be reduced with inexpensive and simple pharmacologic treatment with 5-FU and LMWH and should be used routinely in the treatment of patients at risk of developing PVR.

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Giant retinal tears. Surgical techniques and results using perfluorocarbon liquids.

Sebastian W. Fuchs, H Lincoff, S. Chang … (1989)

Three low-viscosity perfluorocarbon liquids provided an intraoperative tool during vitrectomy to manage giant retinal tears. These clear fluids have a high specific gravity (1.8 to 1.9) and are immiscible with water. In six eyes, the giant tear was less than 180 degrees; in 11 eyes, it was 180 degrees or greater. In all eyes, the tear was unfolded and the retina was flattened while the patient was supine. The perfluorocarbon liquid was aspirated and replaced by air-perfluorocarbon gas mixtures (16 eyes) or silicone oil (one eye) at the end of the operation. The retina was reattached in 16 eyes (94%), with a minimum follow-up period of 6 months. In five eyes (29%), the retina was reattached without scleral buckling. Residual droplets of perfluorocarbon liquid were observed in four patients. These new materials complement present surgical techniques for managing giant retinal tears.

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Author and article information

Journal

Journal ID (nlm-ta): J Ophthalmic Vis Res

Journal ID (iso-abbrev): J Ophthalmic Vis Res

Journal ID (publisher-id): JOVR

Title: Journal of Ophthalmic & Vision Research

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2008-2010

ISSN (Electronic): 2008-322X

Publication date (Print): Jan-Mar 2017

Volume: 12

Issue: 1

Pages: 93-97

Affiliations

[1 ] Department of Ophthalmology, University of Puerto Rico, San Juan, Puerto Rico, USA

[2 ] School of Medicine, University of Pennsylvania Perelman, Pennsylvania, USA

[3 ] Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

Author notes

Correspondence to: Maria H. Berrocal, MD. Department of Ophthalmology, University of Puerto Rico, 140 De Diego Ave., Suite 404, San Juan, Puerto Rico 00909, USA. E-mail: mariahberrocal@ 123456hotmail.com

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Publisher ID: JOVR-12-93

DOI: 10.4103/2008-322X.200158

PMC ID: 5340068

PubMed ID: 28299011

SO-VID: f9b38fa8-c4a7-42e3-bbec-c617fb130122

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Management of Giant Retinal Tear Detachments

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Karger: Ophthalmology

Most cited references 30

Low viscosity liquid fluorochemicals in vitreous surgery.

Adjuvant 5-fluorouracil and heparin prevents proliferative vitreoretinopathy : Results from a randomized, double-blind, controlled clinical trial.

Giant retinal tears. Surgical techniques and results using perfluorocarbon liquids.

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