Contemporary Management of Complex and Non-Complex Rhegmatogenous Retinal Detachment Due to Giant Retinal Tears

Figures & data

Table 1 Contemporary Giant Retinal Tear Series with Microincision Vitrectomy Surgery

Author, Publication Year	Country	Study Design	Inclusion Criteria	Exclusion Criteria	Surgical Repair	Eyes	Mean Age ± SD, Years (Range)	Mean Follow-Up, SD, Months (Range)	SO	Anatomic Outcomes	Visual Outcomes
Gonzalez et al,^Citation12 2013	USA, Florida	Retrospective	GRT	Penetrating trauma	PPV ± buckle (85% PPV+SB)	79	44 ± 18	20±16	57%	SSAS: 82% FAS: 92%	VA improved in 57% 22% final VA ≥ 20/40
Rodriguez et al,^Citation11 2018	USA, Florida	Retrospective	GRT± blunt trauma (18%)	History of retinopathy of prematurity	PPV ± buckle (76% PPV+SB)	80	48 ± 16	10 ± 9	70%	SSAS: 86% FAS: 95%	19% final VA ≥ 20/40
Pitcher et al,^Citation10 2015	USA, Pennsylvania	Retrospective	GRT ± PVR C (17%)	Penetrating trauma	PPV ±buckle (52% PPV+SB)	58	52 (16–83)	17 (3–43)	48%	SSAS: 88% FAS: 100%	35% final VA ≥ 20/40
Falavarjani et al,^Citation25 2017	Iran, Tehran	Retrospective	GRT ± PVR C (23%) or trauma (29%)	Any ocular pathology that could decrease VA	PPV ±buckle (11% PPV+SB)	62	34 ± 20 (4–76)	22 ± 28 (3–126)	100%	SSAS: 76% FAS: 98%	VA improved in 70% 16% final VA ≥ 20/40
Kumar et al,^Citation13 2018	India, New Delhi	Retrospective	GRT	Penetrating trauma	PPV alone	17	Median= 16 (4–70) Children ≤ 16 constituted 53% of cases	10 (7–16)	77%	FAS: 88%	35% VA ≥ 20/80
Hacaoglu et al,^Citation23 2019	Turkey, Istanbul	Retrospective	GRT ± PVR C (16%)	Penetrating ocular trauma	PPV alone	45	43 ± 13, (9–62)	37 ± 35	100%	SSAS: 84% FAS: 98%	64% final VA ≥ 20/40
Kunikata et al,^Citation22 2011	Japan	Retrospective	GRT	Trauma	PPV alone	12	43 ± 15	12 ± 10 (6–39)	100%	SSAS: 92% FAS: 100%	67% of eyes showed visual improvement
Kunikata et al,^Citation20 2020	Japan	Retrospective	GRT	Open globe injuries, obvious mental illness	PPV alone	41	41 ± 18 (9–72)	14 ±8 (6–39)	83%	SSAS: 93% FAS: 100%	95% of eyes maintained or improved VA
Randolph et al,^Citation21 2016	USA, Tennessee	Retrospective	GRT	Previous ocular conditions other than refractive error, glaucoma, or prior cataract surgery, patients <18 years and >75 years	PPV alone	23	50 ± 11	33 ± 20	0% (all cases used MT-PFO)	SSAS: 78% FAS: 91%	48% of eyes showed visual improvement
Li et al, current study	USA, Michigan	Retrospective	All-inclusive GRTs	none	PPV ± buckle (15% PPV+SB)	48	Median= 46 (4–72)	Median=28 (3–124)	19%	SSAS: 67% FAS: 100%	44% final VA ≥ 20/40

Abbreviations: SD, standard deviation, SO, silicone oil, GRT, giant retinal tear; PVR, proliferative vitreoretinopathy; PPV, pars plana vitrectomy; SSAS, single surgery anatomic success; FAS, final anatomic success; VA, visual acuity; MT-PFO, medium-term postoperative perfluoro-n-octane.

Table 2 Initial Demographic, Anatomic, and Functional Characteristics

	N=48 (%)
Median age, years (IQR, range)	46 (29, 4–72)
Sex
Male	40 (83.3)
Female	8 (16.7)
Median follow-up time, months (IQR, range)	28 (43, 3–124)
Eye
Right	24 (50)
Extent of GRT
<180°	35 (72.9)
≥180°	13 (27.1)
Location of GRT
Inferior	29 (60.4)
Superior	19 (39.6)
Macula status
On	17 (35.4)
Off	31 (64.6)
Grade C PVR	7 (14.6)
Lens status
Phakic	31 (64.6)
Non-phakic	17 (35.4)
Median baseline logMAR VA (IQR, range)	1.1 (2.3, 0–2.8)

Note: Non-phakic includes eyes with aphakia or pseudophakia at the time of initial surgery.

Abbreviations: GRT, giant retinal tear; PVR, proliferative vitreoretinopathy; logMAR, logarithm of the minimum angle of resolution; VA, visual acuity; IQR, interquartile range.

Table 3 Operative Approach

Operative Parameters	N (%)
Primary SB	1 (2.1)
Primary PPV	40 (83.3)
Combined PPV/SB	7 (14.6)
Lensectomy or cataract surgery at time of primary procedure	7 (14.6)
Perfluorocarbon liquid use	43 (89.6)
Tamponade
C3F8	39 (81.3)
Silicone oil	9 (18.7)

Abbreviations: SB, scleral buckle; PPV, pars plana vitrectomy; C₃F₈, perfluoropropane.

Table 4 Anatomic Outcomes

Outcome	Estimate
Final anatomic success, N (%)	48 (100%)
Estimated single surgery anatomic success (%, 95% CI) at:
3 months^a	75% (60%, 85%)
6 months^a	75% (60%, 85%)
1 year^a	72% (56%, 83%)
2 years^a	65% (47%, 78%)
Recurrent detachment, N (%)	16 (33.3%)
Presence of PVR	10/16 (62.5%)
Subsequent SB	4/16 (25%)
Median redetachment time after primary repair, months (IQR, range)	1.633 (5.53, 0.23–37.20)
Total number of repairs, N (%)
1	32 (66.7%)
2	12 (25%)
3	4 (8.3%)

Note: ^aKaplan-Meier estimate and 95% confidence intervals (%).

Abbreviations: CI, confidence interval; PVR, proliferative vitreoretinopathy; SB, scleral buckle; IQR; interquartile range.

Table 5 Functional Outcomes

Visual Acuity Range	All Eyes, N=46, (%)		Macula-On Eyes, N=17, (%)		Macula-Off Eyes, N=29, (%)
	Baseline	Final	Baseline	Final	Baseline	Final
logMAR≤ 0.3 (≥ 20/40)	11 (23.9)	20 (43.5)	11 (64.7)	13 (76.5)	0 (0)	7 (24.1)
logMAR >0.3 to ≤ 1.00 (< 20/40 and ≥ 20/200)	10 (21.7)	17 (37)	3 (17.6)	4 (23.5)	7 (24.1)	13 (44.8)
logMAR> 1.00 (< 20/200)	25 (54.3)	9 (19.6)	3 (17.6)	0(0)	22 (75.9)	9 (31)

Abbreviation: logMAR, logarithm of the minimum angle of resolution.

Table 6 Baseline Characteristics and Operative Factors Associated with Single Surgery Success

Continuous Variables	Recurrent Detachment (N=16)		Stable Reattachment (N=32)		P Value^a
	N	Mean (SD)	N	Mean (SD)
Age (years)	15	37.44 (19.92)	32	44.56 (18.72)	0.418
Follow-up interval (months)	16	51.19 (39.64)	32	24.50 (21.18)	0.001
Baseline LogMAR	14	1.66 (1.11)	32	1.2563 (1.03)	0.361
Categorical Variables	N	Percentage	N	Percentage	P value^b
Gender
Male (N=40)	14	87.5	26	81.3	0.701
Female (N=8)	2	12.5	6	18.8
Eye
Right (N=24)	6	37.5	18	56.3	0.359
Left (N=24)	10	62.5	14	43.8
Trauma
No (N=28)	11	68.8	17	53.1	0.363
Yes (N=20)	5	31.3	15	46.9
Grade C PVR presentation
No (N=41)	13	81.3	28	87.5	0.672
Yes (N=7)	3	18.8	4	12.5
Macula Status
Off (N=31)	14	87.5	17	53.1	0.026
On (N=17)	2	12.5	15	46.9
Tamponade agent
Gas (N=39)	12	75	27	84.4	0.457
Silicone oil (N=9)	4	25	5	15.6

Notes: ^aStudent’s t-test; ^bChi-square or Fisher exact test.

Abbreviations: PVR, proliferative vitreoretinopathy; logMAR, logarithm of the minimum angle of resolution.

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