Treatment of giant retinal tears combined with proliferative vitreoretinopathy

Giant retinal tears with foreshortened and stiffened retina secondary to advanced proliferative vitreoretinopathy (PVR) pose a complex problem for the retinal surgeon. In the past, tractional forces on the retina in these eyes have been counteracted temporarily by retinal sutures, retinal incarceration, or retinal tacks, often combined with fluid-gas exchange in the prone position. These techniques are complex and add multiple additional maneuvers to the surgical procedure. The current report describes the use of a simple, stepwise fluid-gas exchange technique with the patient in the supine position in which the expanding gas bubble traps the edge of the stiffened and foreshortened retina against the pigment epithelium. Long-term counteraction of tractional forces was achieved by the use of intraocular silicone oil. Using this technique, 18 of 19 eyes with giant retinal tears and PVR Grade D1 to D3 could be successfully reattached. Four of these successfully reattached eyes had 360 degrees giant retinal tears. The most common and significant complication in our series was the recurrence of periretinal membranes. All 18 eyes that were initially reattached suffered the recurrence of significant periretinal membranes. Four of those 18 eyes developed recurrent interior traction detachments on to four months postoperatively.