Giant Retinal Tears

A giant retinal tear refers to a specific type of retinal detachment.  It is a very uncommon type of retinal detachment and the visual prognosis is often much worse than other retinal detachments.  Blindness is commonly caused by a giant retinal tear.

Usually, in the more common rhegmatogenous retinal detachment, the tears, or holes, in the retina are localized.  Fluid gets underneath the retina through these tears and a retinal detachment forms.

Large Rents in the Retina

Giant retinal tears  are different in that the tear itself extends across at least 25% of the retina.  The tear is so large that the retina commonly folds over itself (same situation if you fold a piece of notebook paper in half, the top half folds over the bottom half).

Proliferative Vitreo Retinopathy (PVR) Causes Recurrent Detachments

These tears are very tricky to fix and about 50% of the time we end up with a blind eye.  It is very difficult to unfold the retina and then keep it attached.  Blindness occurs from repeated, or recurrent, detachments.  A specific condition often develops called proliferative vitreoretinopathy (PVR).  PVR can also cause repeated retinal detachments.  The prognosis, in any condition, worsens when proliferative vitreoretionpathy develops.

PVR is a complication of severe trauma or retinal detachments.  It can occur after the more common rhegmatogenous retinal detachments, but is associated with giant retinal tears 40-50% of the time.  Hence, the large correlation with blindness.

Poor Surgical Outcomes

Surgical techniques have varied over the years and no single technique has really been very successful.  Most attempts using silicone oil or intraocular gas prove to be very cumbersome, difficult to use and are associated with poor results.

Over the past several years, I have had extreme success using a technique involving a “heavy” liquid and a scleral buckle.

Saving Vision with Novel Techniques

Perflouron is a liquid that is heavier than water.  It is used as a tool to unravel the retina and is ideal for giant retinal tears.  The liquid gently manipulates the retina back into it proper position, laser is applied to the detached area and the first part of the treatment is completed.

The laser will take a few days or weeks to cause sufficient scarring.  Meanwhile, the Perfluoron keeps the retina in place.  Patients are usually kept on their back looking at the ceiling during this time.  The liquid is later removed.

Inflammation inside the eye can occur, but it is usually well tolerated.

Many surgeons will also recommend some form of treatment (laser, cryo or scleral buckle) to the other eye for prophylaxis against a similar retinal detachment.  This is not true of the more common rhegmatogenous retinal detachments.

What Does This Mean? Giant retinal tears are uncommon.  It is difficult to really understand a disease that occurs only once in a while.  With surgical and visual outcomes so poor, there is really no “standard of care” for the treatment of giant retinal tears.

The treatment regimen I prefer requires the treatment to be broken into two separate operations.  The outcomes, thus far, have been nothing short of spectacular, especially given that this is a blinding condition.

A large study would be necessary to validate my approach.  I would love to hear if others have had similar experiences.



Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia

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***This post is for information purposes only. This posting does not offer legal or medical advice, so nothing in it should be construed as legal or medical advice. The information on this blog/post is only offered for informational purposes. You shouldn’t act or rely on anything in this blog or posting or use it as a substitute for legal/medical advice from a licensed professional. The content of this posting may quickly become outdated, especially due to the nature of the topics covered, which are constantly evolving. The materials and information on this posting/blog are not guaranteed to be correct, complete, or timely. Nothing in this posting/blog and nothing you or I do creates a doctor-patient relationship between you and the blog; between you and me; or between you and Randall Wong, M.D. or RetinaEyeDoctor.com. Even if you try to contact me through the blog or post a comment on the blog you are still not creating a doctor-patient relationship. Although, I am a doctor, I’m not YOUR doctor until and unless there is a written agreement specifically providing for a doctor-patient relationship.***

Comments

  1. Leonor ANDRADE says:

    es normal q ue te saquen el cristalino para operarte de desprendimiento de retina y no te pongan lente ocular

  2. He traducido tu opinión a través de Google. Por favor, comprenda que no sé mucho español.

    Parece que usted le pregunta si es normal a fin de que el lente cristalino natural durante la reparación de desgarros retinianos gigantes.

    Es muy apropiado para extraer el cristalino durante toda la cirugía del desprendimiento de retina, especialmente para los desgarros retinianos gigantes.

    Espero que esto ha sido útil.

    Randy

  3. Russ Smith says:

    My name is Russ Smith and I am very interested in your work with perfluoron for reducing PVR in retinal trauma cases as I appear to have a similar circumstance.

    I would greatly appreciate it if you could take the time and read over my situation and offer any opinions, recommendations or suggestions you may have. If you could recommend any doctors in the Dallas area that are familiar and have used perfluoron, I would appreciate it also. I am willing to travel to see you or anyone you recommend.

    I am a 52 year old male in Dallas that has had the unfortunate accident of having a finger in my eye while playing basketball on the morning of Friday, September 3, 2010. Dr. Shashi Dharma operated on my eye that day to close a large global perforation that was about a 9mm tear from 12:00 to about 3:00 on my left eye. She was able to close the eye after a 3 hour surgery. Dr. Dharma wanted to give the closure time to heal. On September 21, I went in for a vitrectromy performed by Dr Dharma. She seemed pleased with it as the retina laid back nicely, the lens was able to stay in, and silicone oil was placed in my eye. On Thursday, Sept 22, at my post-op check everything looked exceptionally well. However, by Wednesday, Sept. 28, Dr Dharma noted that there was scar tissue developing such that my retina was lifting at the bottom of my eye and there was some fluid behind retina. She had me continue to try to stay face down as much as reasonably possible. She did some laser work on Friday and Monday (Oct. 4th). However, on Monday she was very concerned about the PVR (mostly in the inferior section) and thought that we should get other opinions on next course of action.

    This is the purpose of my reaching out to you. After researching, it appears that I am a good candidate for perfluoron. I am interested in your opinions on my situation and would like to know any recommendations or suggestions you may have.

    Thank you in advance for your time.

    Russ Smith
    Dallas, TX

  4. Russ,

    Thanks for your inquiry.

    I am not in a position to recommend Perfluoron as I have not examined you, however, I could make some general remarks regarding my experience using the liquid.

    Remember this is not an FDA approved use of the material. I have found the liquid to be invaluable tool to reattaching the retina during surgery and usually keeping it that way after surgery, especially for giant retinal tears. The amount of scar tissue presently forming would be of greatest concern and I can’t say that this would absolutely benefit your case.

    My experience with the “PFO” is that there is a good chance at limiting the number of repeat detachments, and therefore, enhances the chances of having useful vision once stabilized.

    Certainly, there is no harm in your getting a second opinion…soon.

    If I can help further, please re-comment. Feel free to email me as well RWong@RetinaEyeDoctor.com. My office staff could also help you with travel arrangements if you so desired. We are close to Dulles and Reagan airports.

    Stay in touch. All the best.

    Randy

  5. Alvin Nucum says:

    Good day,
    I am a 46 y/o male, diagnosed to have a giant tear from my 9 o’clock to 12.Underwent vitrectomy, gas bubble and perfluoron.I am on my 21st day post with perfluoron still in there.Scleral buckling was not done.Would it be still possible to have retinal detachment under the area where the perfluoron is?I would appreciate any response.
    Thanks.

  6. Dear Alvin,

    If indeed you have Perfluoron, it is possible that the area of original detachment can detach again….giant retinal tears are often associated with PVR (proliferative vitreo retinopathy).

    What are the plans to remove the Perfluoron?

    Randy

  7. Alvin Nucum says:

    Dear Dr.Randy,
    Thank you for your swift response.I usually have my follow up check ups on a Tuesday and Friday.My doctor mentioned about removing the Perfluoron any time soon no later than the end of October with a tuberculin syringe.I also had laser done yesterday to reinforce the one done intra op.
    Again thanks,
    Alvin

  8. Alvin Nucum says:

    Dear Dr.Randy,
    Just an update.Had the Perfluoron removed yesterday by Stelaris under General Anesthesia?Cryotheraphy and Gas was also done.
    When they suctioned the PFR, they noted wrinkling in the area, so they re introduced the PFR for a few minutes to flatten the area.The doctor mentioned something about “slippage”?
    The cryotheraphy was done on a quarter of the eye.
    In your experience if this doesn’t work, would silicone oil and scleral buckling be an option?
    Again thanks,
    Alvin

  9. Mike Brooks says:

    Dr. Wong,
    I had a Gaint Retinal Tear 3 years ago. I have had a preventative laser treatment to my other eye suggested. Do you have any experience with this?
    Thanks

  10. Dear Mike,

    Yes, it is standard of care to laser the other eye in cases of giant retinal tears.

    For other readers, giant retinal tears are a special type of retinal detachment often leading to complete blindness and are really distinct from the more common rhegmatongenous retinal detachments.

    Get the laser done.

    Randy

  11. Thomas Van Vooren says:

    I am 1 mo. post op from retina detachment with a giant tear surgery.(180 degree verticle temporal) Surgery consisted of scleral buckle, perfluoron,silicone oil. Treatment is complicated by the presence of a cataract. Yesterday I received a new lense, and vision has improved some. My question is this. I am not getting a lot of info from my surgeon concerning time frame for silicone oil removal and cataract removal, or risks and complications.
    I am a dentist, but am in the position of not having to rush treatment. I want to do this with the optimal time frame used. Also what complications could prevent me from practicing again? If this is too much info for you to provide, please send me info on where I can do my own research.
    Thamks

  12. Thomas,

    Obviously, you know the value of an exam. I don’t have that advantage.

    I would wait a minimum of 6 weeks. Nothing but my experience saying 6 weeks is probably okay. My usual method of fixing giant retinal tears is to infuse Perfluoron and leave it for 2-6 weeks.

    This may be a round about way of answering your question. Sorry I’m not of more help.

    r

  13. vijay yadav says:

    dear sir
    I am 24 male from Nepal
    i have giant retinal tear in my right eye with PVR
    i had eye trauma 8-9 months back but it was not that bad at that time.my vision was ok
    but from last 2 month i started feeling that my vision is deteriorating day by day.
    and then i diagnosed and found that i have GRT with PVR.
    so i am looking for my retina detachment surgery
    my left eye is perfectly fine
    i still have some vision in my right eye but very less
    sir i need your opinion about the surgeries and its outcomes.
    i understand that i cant get the same vision but now am more concern about
    my retina.
    sir please advice me your opinion as soon as possible
    thank you

  14. Vijay,

    Your biggest concern should be to get the retina reattached. This may not translate into better vision, but may prevent you from losing the eye, and, giving you every hope of improvement. GRT and PVR each carry a poor visual prognosis.

    r

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  1. […] Giant retinal tears (GRT) are the worst type of retinal detachment.  These types of retinal detachment have higher surgical complications, are more difficult to fix and often lead to legal blindness or worse. […]

  2. […] fix giant retinal tears in […]

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