GIANT RETINAL TEAR DETACHMENT: Clinical Presentation and Treatment Outcomes in 396 Patients

Management of macula-on giant retinal tear detachments- outcome of pars-plana-vitrectomy with silicone oil versus gas tamponade

BACKGROUND

To compare the outcome of eyes with a macula-on giant retinal tear (GRT) detachment treated with pars-plana-vitrectomy (PPV) depending on the used endotamponade.

METHODS

All consecutive cases with a macula-on GRT-associated rhegmatogenous retinal detachment (RRD) managed with PPV between 2007 and 2022 were retrospectively assessed depending on the selected endotamponade. By reviewing medical charts and surgical protocols the pre- and intraoperative parameters were analysed in detail. The number of vitreoretinal (VR) procedures needed for reattachment, the redetachment rate and the functional outcome were evaluated. Eyes treated with primary silicone oil (SO) tamponade were compared to eyes with primary gas tamponade. Cases with pre-existing conditions affecting outcome e.g. macula-off situation, history of trauma, status after complicated cataract surgery, former VR surgery or proliferative vitreoretinopathy grade C or higher were excluded.

RESULTS

Overall, 51 eyes of 45 patients with a macula-on GRT detachment were treated with PPV and SO (n = 32; 63%) or gas (n = 19; 37%) endotamponade in the observed period. Eyes with primary SO tamponade underwent on average 2.3 (SD 0.8) VR procedures and had a redetachment rate of 13% (n = 4). Eyes with gas tamponade showed a higher redetachment rate of 32% (n = 6) with a mean number of 1.6 (SD 1.0) PPV procedures. Postoperative best-corrected visual acuity (BCVA) was significantly better in eyes with primary gas tamponade (mean logMAR BCVA 0.32; SD 0.30) compared to eyes with SO (mean logMAR BCVA 0.60; SD 0.42; p = 0.008).

CONCLUSIONS

Surgical management of GRT-associated RRDs is complex. In clinical routine often SO is used as endotamponade. Because of known disadvantages (second procedure necessary for SO removal, unexplained SO-related visual loss, secondary glaucoma, SO emulsification) some VR surgeons prefer a gas tamponade. In our cohort, eyes with a gas compared to SO tamponade showed higher redetachment rates. However, the final postoperative BCVA was significantly better in eyes with gas compared to SO tamponade.

TRIAL REGISTRATION

The trial protocol was approved by the local ethics committee on 25th of November 2022 (Ethikkommission der Universität Regensburg, Votum 22-3166-104).

Factors influencing dominant eye selection in refractive surgery patients: A correlation analysis

OBJECTIVE

This study aims to reveal the factors influencing the selection of the dominant eye in refractive surgery patients, and enhance the accuracy of clinical evaluation and surgical treatment.

METHODS

A retrospective study method was employed. The ocular biometric parameters were analyzed in 4,114 patients who underwent refractive surgery at the affiliated hospital of Southwest Medical University from 2019 to 2023.

RESULTS

The study found that 79.07% of the patients had the right eye as the dominant eye, while 20.93% had the left eye. Although there was no significant difference between the dominant and non-dominant eyes in terms of uncorrected visual acuity and Kappa angle, the dominant eye performed better in aspects such as spherical lens, eye axis, and corneal flat curvature. Furthermore, univariate and multivariate logistic regression results showed that best-corrected visual acuity, pupil diameter, horizontal displacement x-value of the Kappa angle, and astigmatism vector J45 were significant influencing factors for the selection of the dominant eye.

CONCLUSION

There are numerous factors affecting the dominant eye, and the most important core factor is J45. This study comprehensively evaluated the possible factors affecting the dominant eye in patients undergoing refractive surgery, which provides a foundation for the designation of refractive surgical modalities and assurance of surgical outcomes, and opens up new perspectives on understanding the mechanisms of the formation and development of the dominant eye.