Critical Analysis of Postoperative Outcomes in Rhegmatogenous Retinal Detachment Associated with Giant Tears: A Consecutive Case Series Study

Abstract

Background: Currently there remains controversy in the surgical management of rhegmatogenous retinal detachment (RRD) due to giant retinal tears (GRTs), a potentially blinding condition. To clarify which surgical technique is better depending on the origin and magnitude of the giant tear this study aimed to analyze the anatomic and functional outcomes. To analyze trans- and postoperative surgical complications, we used long-term final postoperative structural, optical coherence tomography (OCT) and correlated the results with the final postoperative best-corrected visual acuity (BCVA) in three different groups of eyes. Methods: A long-term, comparative, retrospective, consecutive case series on seventy-six eyes of 66 patients that were recruited and classified according to the degree of GRT-associated RRD extension as follows: group 1 (n = 42 eyes) with GRT-associated RRD extension < 180°; group 2 (n = 23 eyes) with GRT-associated RRD extension = 180°-270°; and group 3 (n = 11 eyes) with GRT-associated RRD extension > 270°. Structural and functional outcomes were compared across groups. Results: Of the 76 eyes analyzed, 63 were phakic, and 13 were pseudophakic. The mean age of the patients was 43.0 ± 13.0 years (range, 19-76 years); 36 females, and 40 males. The mean preoperative time for GRT surgery was 1.8 weeks, the mean preoperative and postoperative BCVA was 1.87 logMAR and 0.35 logMAR, respectively (p < 0.05), and the mean postoperative follow-up was 28.1 months. Five patients (6.6%) had bilateral GRT-associated RRD, 61 patients (80.3%) had a monocular condition, and 21 eyes (27.6%) had final BCVA of ≥ 20/40. Proliferative vitreoretinopathy resulted in multiple surgeries in 31.6% of the eyes. Postoperative OCT yielded abnormal retinal thickness, ellipsoid zone (EZ) disruptions, and external limiting membrane (ELM) line discontinuities in all groups, predominantly in GRTs macula off-associated RRD requiring multiple surgeries. Conclusions: Multiple structural alterations in spectral-domain OCT biomarkers were observed. Eyes that developed secondary epiretinal membrane (ERM) proliferation showed significantly improved BCVA after proliferation and the internal limiting membrane (ILM) was removed. The structural findings correlated with the BCVA allow us to conclude severe consequences of the macular structure and that, despite a fully reattached retina without ERM proliferation, GRTs-associated RRD has a guarded functional prognosis.