Are outcomes of surgery for retina detachments from giant tears worse than from other holes and tears in this era of small gauge vitrectomy and perflorocarbon use in Sub-Saharan Africa?

Management, risk factors and treatment outcomes of rhegmatogenous retinal detachment associated with giant retinal tears: scoping review

BACKGROUND

Rhegmatogenous retinal detachment (RRD) is a serious condition that occurs when the retina detaches from its underlying retinal pigment epithelium. RRDs associated with giant retinal tears (GRTs) are caused by retinal tears at least 90° or one-quarter of the circumferential extent. This scoping review systematically identifies and summarizes clinical studies evaluating surgical techniques for the management of GRT-related RRDs, discusses functional and visual outcomes and the risk factors affecting treatment outcomes.

METHODS

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, Google Scholar, and Springer Link databases were searched for relevant papers (from January 2001 to March 2023). Studies that were published in the English language and reported the risk factors, management, and treatment outcomes of GRT-related RRDs were included in the review. The outcome measures included anatomic success rates, changes in BCVA (logMAR) from baseline to the final follow-up, and adverse events.

RESULTS

A total of 11,982 articles were identified. After the title and abstract review, 71 studies were deemed eligible for full-text review. Thirty-six studies that met the eligibility criteria were included in the final review. Four surgical techniques were identified: pars plana vitrectomy (PPV), combined PPV and scleral buckling, scleral buckling alone, and pneumatic retinopexy. Various types of tamponades, including gas, silicone oil, and air, have been used. PPV was the most commonly used surgical technique in 33.1-100% of patients. Among the 20 studies that used PPV alone, 17 were associated with preoperative PVR. In addition, scleral buckling alone or in combination with PPV was reported as a treatment option in 10 studies, with 2-100% of patients experiencing scleral buckling alone and 13.6-100% experiencing combined PPV and complementary scleral buckling. Primary anatomic success (PAS) was achieved with retinal reattachment via a single operation with no residual tamponade, whereas final anatomic success (FAS) was achieved via more than one operation with no residual tamponade. Reported single surgery anatomic success (SSAS) rates range from 65.51 to 100%. The preoperative best-corrected visual acuity (BCVA) ranged from 0.067 to 2.47 logMAR, whereas the postoperative BCVA ranged from 0.08 to 2.3 logMAR. An improvement in visual acuity was observed in 29 studies. Cataracts (3.9-28.3%) were the most common postoperative complication, followed by high IOP (0.01-51.2%) and PVR (0.8-31.57%).

CONCLUSION

PPV is the most common surgical technique, and currently microincision vitrectomy surgery (MIVS) systems are commonly employed. Silicone oil is the most frequently used tamponade in RRD repair. Risk factors for GRT-related RRD include age, sex, lens status, high myopia status, proliferative vitreoretinopathy (PVR), presenting visual acuity, the extent of the GRT and retinal detachment, and macular involvement. Future research areas include guidelines to reduce variability in the reporting of surgical methodology, choice of tamponades, and reporting of functional and visual outcomes to inform the best therapeutic interventions in GRT-related RRD.

Surgical outcomes and prognostic factors in traumatic retinal detachment following closed-globe injuries

PURPOSE

To evaluate the anatomical and functional results of retinal detachment (RD) surgery following closed-globe injuries (CGI).

METHODS

Patients treated with vitreoretinal surgeries due to RD following CGI from 2014 to 2020 were retrospectively reviewed. Data included demographics, mechanism of injury, preoperative evaluation, and surgical intervention. Outcome measurements included anatomic success, best corrected visual acuity (BCVA), and possible prognostic factors.

RESULTS

A total of 67 eyes from 64 patients (49 males; mean age 52.84 years) were included. The most common causes of the CGI were work-related injury (22.4%) and traffic accidents (23.9%). The primary and final anatomic success rates were 80.6% (54/67) and 89.6% (60/67), respectively. In the multivariable analysis of the logistic regression models, the poor prognostic factor was proliferative vitreoretinopathy (PVR) (P = 0.009) for primary anatomic success. The median preoperative and final BCVA were logMAR 0.7 (IQR, 0.3-1.6) and logMAR 0.5 (IQR, 0.1-1.1), respectively (P = 0.077). Poorly presenting BCVA (counting fingers or worse) and giant tear were associated with poor visual outcomes.

CONCLUSION

Work-related injuries and traffic accidents are the prevalent causes of RD following CGI. The anatomic outcomes were favorable, but visual outcomes varied. Poor prognostic factors included PVR and poorly presenting BCVA, highlighting the importance of a careful initial evaluation.