Surgical treatment of giant retinal tears with inverted posterior retinal flaps

We treated 23 consecutive cases of giant retinal tears with inverted retinal flaps. We used pars plana vitrectomy together with an intravitreal bubble to unfold the posterior retinal flap, combined with cryotherapy to cause a chorioretinal adhesion and a broad scleral buckle. The vitrectomy was done after applying cryotherapy so viable retinal pigment epithelial cells in the vitreous cavity could also be removed. Thirteen eyes had giant tears measuring 90 to 180 degrees (Group 1), eight eyes had giant tears measuring 180 to 270 degrees (Group 2), and two eyes had giant tears larger than 270 degrees (Group 3). The retina was successfully reattached in 11 of the 13 eyes in Group 1, each of the eight eyes in Group 2, and one of the two eyes in Group 3. We believe that vitrectomy and lavage of the vitreous cavity after applying cryotherapy was important in reducing the incidence of proliferative vitreoretinopathy and improving our success rate.