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
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