Rhegmatogenous Retinal Detachment Associated with Giant Retinal Tears: The Effect of Tamponade Choice on Outcome

Rhegmatogenous retinal detachment (RRD) associated with giant retinal tears (GRTs) are treated with vitrectomy but choice of intraocular tamponade is difficult and practice varies amongst vitreoretinal surgeons. We sought to investigate the variables that determine choice of tamponade and how these may affect anatomical and visual outcomes.

Cohort study of routinely collected data from the European Society of Retina Specialists and British and Eire Association of Vitreoretinal Surgeons vitreoretinal surgery outcomes database between 2011 and 2024. Consecutive eyes with GRT and primary RRD surgery that had vitrectomy, and either gas or silicone oil (SO), were included. Revision surgery or secondary causes of GRT including trauma and inflammation were excluded. The type of tamponade used was analysed by a range of baseline variables including macular status, GRT extent and the lowest GRT extent. Multivariable logistic and linear regression were used to investigate the association between baseline variables and surgical technique, including tamponade choice, on primary anatomical success and postoperative visual acuity (VA).

215 eyes with GRT associated RRD were analysed. The mean age was 53 years, 80% were male, 63% phakic, and 7% had proliferative vitreoretinopathy (PVR) grade C. 58% of the cases were macula on. Overall, 50% of the eyes received SO tamponade and 50% gas. SO was used in more of the macula off cases and in eyes with larger GRTs. Overall, 187 of the 215 (87%) eyes achieved primary anatomical success, with 88% of gas tamponade cases achieving primary success versus 86% of the oil cases. Data on visual outcomes were available on 196 eyes of the 215 eyes. Overall, 57% of these eyes achieved 0.3 logMAR postoperative VA or better, with higher percentages in the gas compared to the oil group (78% versus 36%). Multivariable analysis found that tamponade type was not associated with anatomical outcome. The only factor associated with a reduced anatomical success rate was PVR C (odds ratio [OR] 0.29 (95% confidence interval (CI) 0.09-0.90) p = 0.03). Multivariable analysis found that postoperative VA was significantly better with gas compared to SO with oil. Overall, the odds of achieving a VA of 0.3 logMAR or better were at least 2 times higher with gas as compared to oil (OR 4.65 (95% CI: 2.41, 8.99), p < 0.001), rising to at least 5 times higher in the subgroup of patients with a VA of 0.3 logMAR or better at baseline (OR 17.56 (95% CI 5.15, 59.89), p < 0.001).

Our results show that gas tamponade has a similar anatomical success rate to SO, but better visual outcomes in the repair of GRT-associated RRD. Further studies are needed to confirm these findings and inform tamponade choice.