Post-traumatic posterior giant retinal tear and macular hole associated retinal detachment

Background: Blunt trauma to the eye can present with varied manifestations involving both the anterior and posterior segments of the eye. Giant retinal tear (GRT) following trauma occurs most commonly at the equatorial region or anterior to the equator. GRT posterior to the equator is rare. Purpose: To demonstrate the successful management of a post?traumatic posterior GRT and full?thickness macular hole (MH) associated retinal detachment (RD). Synposis: A 21?year?old?male presented with sudden diminution of vision in the right eye (RE) following blunt?trauma with cricket ball. RE vision at presentation was hand movement close to face. Anterior segment of RE revealed pupillary sphincter tear, posterior synechiae and posterior subcapsular cataract (PSC). RE fundus revealed a posterior?GRT, full thickness MH, mild vitreous haemorrhage and rhegmatogenous RD. He was managed with pars plana vitrectomy, encircling scleral band, perfluorocarbon liquid?assisted flattening of GRT, internal limiting membrane peeling, and endotamponade. Post?operatively the retina was attached, MH was closed and the patient achieved an ambulatory vision of 1/60. Highlights: This video demonstrates the successful management of a posterior?GRT and MH associated RD. Removal of adherent hyaloid from the long anterior flap of posterior GRT, peeling of ILM from temporal narrow mobile strip of retina (which has a risk of radial extension of GRT edges) and manoeuvring in suboptimally dilated pupil are illustrated in this video.

Current status and progress of surgical management of giant retinal tear / 眼科新进展

Giant retinal tear (GRT) refers to a retinal break extending circumferential for ≥ 3 clock hours (＞90°) of the retinal with trailing edge folding.With the de velopment of technology,success rate of surgical for GRT was increased.Chandelier illumination can help surgeons complete the operation by themselves,and 23 G,25G,27G microsurgical techniques make it easy for the application of surgical instruments and amplify the scope of operation.Meanwhile,endoscope can reduce the impact of refractive media opacity.Administration of preoperative intraocular medicine is helpful for the operation.However,there is no definite findings of whether adjuvant scleral buckling and lens extraction are necessary in the management of GRT as well as how to deal with retinal stiff and flap of GRT.And this article tries to summarize the pathogenesis,surgical methods and pre-and post-operative stuffing of the GRT.

Current status and progress of surgical management of giant retinal tear / 眼科新进展

Giant retinal tear (GRT) refers to a retinal break extending circumferential for ≥ 3 clock hours (＞90°) of the retinal with trailing edge folding.With the de velopment of technology,success rate of surgical for GRT was increased.Chandelier illumination can help surgeons complete the operation by themselves,and 23 G,25G,27G microsurgical techniques make it easy for the application of surgical instruments and amplify the scope of operation.Meanwhile,endoscope can reduce the impact of refractive media opacity.Administration of preoperative intraocular medicine is helpful for the operation.However,there is no definite findings of whether adjuvant scleral buckling and lens extraction are necessary in the management of GRT as well as how to deal with retinal stiff and flap of GRT.And this article tries to summarize the pathogenesis,surgical methods and pre-and post-operative stuffing of the GRT.

Vitrectomy with Perfluorocarbon Liquid versus Combined Encircling for Retinal Detachment with Giant Retinal Tear

PURPOSE: To evaluate the clinical usefulness of additional encircling in patients treated for retinal detachment with giant retinal tear and without proliferative vitreoretinopathy, compared to single vitrectomy using perfluorocarbon liquid. METHODS: Patients who underwent surgery for retinal detachment with giant retinal tear were divided into either the vitrectomy alone group or combined vitrectomy and encircling group. We reviewed the primary anatomical success rate, final anatomical success rate and best corrected visual acuity (BCVA) at the last follow-up (log MAR). Additionally, BCVA at the first visit, intraocular pressure, lens status, history of intraocular surgery, high myopia, trauma history, time from symptom onset to surgery, location and size of the giant retinal tear, extent of retinal detachment and foveal detachment were reviewed. RESULTS: Among a total of 29 eyes, the vitrectomy alone group included 8 eyes and the combined group 21 eyes. Location and size of the giant retinal tear, extent of retinal detachment and foveal detachment, intraocular pressure, history of intraocular surgery, lens status, high myopia, trauma history and time from symptom onset to surgery were not different between the 2 groups. The primary success rate was 87.5% in the vitrectomy group and 85.7% in the combined group; the final surgery success rate was 100.0% and 95.2%, respectively. There was no significant difference in the anatomical success rate between the 2 groups. The postoperative BCVA was similar in both groups (0.80 vs. 0.92). CONCLUSIONS: When vitrectomy using perfluorocarbon liquid was performed for the treatment of giant retinal tear without proliferative vitreoretinopathy, an encircling provided no additional benefit for the anatomical success rate and visual recovery. Only intensive vitrectomy of peripheral retina was considered capable of achieving a successful retinal attachment in patients without proliferative vitreoretinopathy.

Perfluoro-N-octane as Postoperative Vitreous Substitutes in Retinal Detachment: A Case Report

PURPOSE: To report a case of retinal detachment with a giant retinal tear, which was treated with perfluorocarbon liquid as an intraocular substitute. CASE SUMMARY: A 37-year-old woman with a dislocated lens and a giant retinal tear underwent vitrectomy and lensectomy and was instructed to maintain a supine position after the operation. Perfluorocarbon liquid (Perfluoro-N-octane, C8F18) was used as a substitute in the vitreous cavity for 17 days. After 17 days, the perfluorocarbon liquid was removed and intraocular lens scleral fixation was performed. After removal of the perfluorocarbon liquid, the corneal endothelium was stable without other complications (including corneal edema, elevated intraocular pressure, ocular hypotony, macular pucker), and the best corrected visual acuity after intraocular lens scleral fixation was 0.4. CONCLUSIONS: Perfluorocarbon liquid is a useful surgical material in patients with a dislocated lens and retinal detachment with a giant retinal tear who have difficulty maintaining a prone position.

Vitrectomy in Severe Giant Retinal Tear

PURPOSE: To determine the results of pars plana vitrectomy (PPV) for the treatment of severe giant retinal tear. METHODS: We analyzed the clinical records of patients who had 150degrees or greater of giant retinal tear and underwent PPV. RESULTS: Of all 10 patients (10 eyes), 7 were male patients and mean age was 29.8 years. Giant retinal tear was idiopathic in 6 eyes and traumatic in 1 eye, and occurred after vitrectomy in 3 eyes. Primary operations were scleral buckle in 1 eye, PPV with intraocular gas injection in 2 eyes and with silicone oil (SO) injection in 7 eyes. In 3 eyes without SO injection, secondary operations were PPV with intraocular gas injection in 1 eye and with SO injection in 2 eyes. In 1 eye with PPV and intraocular gas injection, tertiary operation was PPV with SO injection. Removal of SO was done in all 10 eyes and SO was re-injected due to proliferative vitreoretinopathy in 2 eyes. Visual acuity was counting fingers or worse in 8 eyes before the primary operation and, on the final visit, 0.1 or better in 6 eyes and 0.3 or better in 3 eyes. CONCLUSIONS: These results suggest that PPV with SO injection might be better for the treatment of severe giant retinal tear than with intraocular gas injection.

A Case of Giant Retinal Tear in Atopic Dermatitis

Retinal detachments occuring in atopic dermatitis patients are usually associated with tears of peripheral retina or nonpigmented epithelium of the ciliary body or retinal dialysis. It has been considered relatively rare, however, its clinical reports have been increasing recently. We experienced a case of atopic dermatitis with retinal detachment of right eye caused by giant retinal tear and retinal tear of left eye in 23-year-old male, we could obtain successful result by treating his right eye with scleral buckling procedure and intravitreal gas injeciton.