Management of giant retinal tear detachment successful with vitrectomy alone

Study author says he does not recommend routine use of scleral buckling combined with vitrectomy.

Issue: December 25, 2014

Scleral buckling in giant retinal tear detachment may be unnecessary because the detachment can be managed successfully with vitrectomy alone, according to a study.

“Scleral buckling is often not needed as an adjunct to vitrectomy when repairing a retinal detachment caused by a giant retinal tear,” David N. Zacks, MD, PhD, told Ocular Surgery News.

The study was published in Ophthalmic Surgery, Lasers and Imaging Retina.

Patients and methods

The retrospective study included 41 eyes of 40 patients who received pars plana vitrectomy alone for primary giant retinal tear detachment within a 20-year time frame. Patients underwent three-port pars plana vitrectomy and were followed up at 1 day, 1 week and 1 month.

While scleral buckling was usually well-tolerated by patients, it was also associated with several complications.

“I would not recommend routine use of a scleral buckle in combination with vitrectomy. It might be useful in specific situations, such as when there is proliferative vitreoretinopathy present,” Zacks said.

Prophylactic 360° endolaser photocoagulation was used sparingly in eyes with diffuse retinal pathology.

“Inasmuch as idiopathic [giant retinal tear] eyes tend to have multiple breaks, 360° endolaser photocoagulation can help prevent redetachment from missed retinal breaks,” the researchers said.

Retrospective results

At baseline, 22 eyes were phakic, 22 eyes had macula-sparing detachment, and six eyes had grade C proliferative vitreoretinopathy. No significant difference was found between phakic and nonphakic eyes in baseline clinical and operative features.

After a single reattachment surgery, the success rate was 83% at 3 months and 75% at 2 years. Successful reattachment was attained in 91% of phakic eyes at 3 months. Final logMAR best corrected visual acuity was 20/40 or better in 23 eyes and worse than 20/200 in seven eyes.

Eight of nine eyes with recurrent detachment required additional reattachment surgery. Of these eyes, three underwent scleral buckling and five underwent silicone oil tamponade.

“I generally use gas tamponade with C₃F₈ in the setting of a giant retinal tear. The advantages are that it works well and does not require a second surgery for removal. Silicone oil might be considered when the patient cannot position properly or has an urgent need for air travel,” Zacks said.

No cases of endophthalmitis, macular fold or clinically significant retinal slippage occurred in the study.

“[Giant retinal tear]-associated retinal detachment should be treated as any other rhegmatogenous retinal detachment. The goal of the surgery is to carefully identify and treat all retinal breaks, relieve any significant traction on the breaks and provide sufficient tamponade until the retinopexy has matured,” the researchers said. – by Nhu Te

Reference:

Jain N, et al. Ophthalmic Surg Lasers Imaging Retina. 2014;doi:10.3928/23258160-20140908-03.

For more information:

David N. Zacks, MD, PhD, can be reached at Kellogg Eye Center, 1000 Wall St., Ann Arbor, MI 48105; 734-763-7711; email: davzacks@med.umich.edu.
Disclosure: Zacks has no relevant financial disclosures.