Our Summary
This research studied the causes, symptoms, and outcomes of patients with a serious eye condition called giant retinal tear detachment at a major eye hospital. The study looked at 396 patients who had surgery for this condition.
The average patient was 37 years old, and the majority (86%) were men. The main causes of the condition were injury (21%) or severe short-sightedness (11%). Most of the patients had a tear in their retina that was larger than half the size of the retina, and many of them had a part of the retina detached or the central part of the retina (macula) detached.
There were three main types of surgeries performed: one that involves removing the vitreous (a gel-like substance in the eye) and replacing it with a gas bubble (61%), another that combines the previous surgery with placing a silicone band around the eye (38%), and a third type that involves placing a silicone band around the eye without removing the vitreous (1%).
The patients were followed up for an average of 15 months after surgery. After the first surgery, 64% of the patients had successful reattachment of the retina. This success rate improved to 78% after a second surgery in those patients where the retina detached again.
Before surgery, the average patient could only see the big E on the eye chart. After surgery, they could see down to the fourth line on the chart, which is a significant improvement. However, only 15% of patients could see well enough to drive without glasses after surgery.
The study concluded that injury and severe short-sightedness are the main causes of giant retinal tear detachment. The surgery, which involves removing the vitreous, placing a silicone band around the eye, and replacing the vitreous with a gas bubble, had good outcomes in terms of reattaching the retina and improving vision.
FAQs
- What are the major risk factors for giant retinal tear detachment?
- What types of surgeries are performed for giant retinal tear detachment?
- What factors are associated with poor anatomical success in the treatment of giant retinal tear detachment?
Doctor’s Tip
One helpful tip a doctor might tell a patient about retinal detachment surgery is to follow post-operative instructions closely, including avoiding strenuous activities and keeping the head elevated as directed to promote proper healing and reduce the risk of complications.
Suitable For
Patients with giant retinal tear detachment, particularly those with trauma or high myopia as predisposing risk factors, are typically recommended for retinal detachment surgery. This study found that surgery with pars plana vitrectomy with or without encirclage band and silicone oil tamponade had good anatomical and visual outcomes for patients with giant retinal tear detachment. Factors associated with poor anatomical success included age <16 years and presenting visual acuity of 20/400 or less. Overall, the study suggests that surgery is effective in treating giant retinal tear detachment and can lead to favorable outcomes in terms of anatomical and visual success.
Timeline
-Before surgery: The patient may experience symptoms such as sudden onset of floaters, flashes of light, and a curtain-like shadow over their vision. They may seek medical attention and undergo a comprehensive eye examination, including imaging tests like ultrasound or optical coherence tomography, to confirm the diagnosis of retinal detachment.
-Surgery: The patient will undergo retinal detachment surgery, which may involve techniques such as pars plana vitrectomy, scleral buckle, or a combination of both. The surgery aims to reattach the retina to the back of the eye and seal any tears or breaks in the retina. Silicone oil or gas may be used as a temporary tamponade to support the reattachment of the retina.
-After surgery: The patient will have follow-up appointments to monitor the healing process and assess the success of the surgery. They may need to maintain a face-down position for a period of time to help the retina reattach properly. Visual acuity and visual field tests will be conducted to evaluate the functional outcomes of the surgery. The patient may experience improvements in vision over time, although some degree of visual impairment may persist depending on the severity of the detachment and any pre-existing eye conditions.
What to Ask Your Doctor
What is the underlying cause of my retinal detachment and are there any specific risk factors I should be aware of?
What are the different surgical options available for treating my giant retinal tear detachment and which one do you recommend for me?
What are the potential risks and complications associated with retinal detachment surgery?
What is the expected outcome of the surgery in terms of restoring my vision?
How long is the recovery process after retinal detachment surgery and what kind of follow-up care will be required?
Will I need to undergo any additional procedures or treatments after the initial surgery?
Are there any lifestyle changes or precautions I should take to prevent future retinal detachments?
What are the chances of the retinal detachment recurring in the future and how can I best monitor for any signs of recurrence?
How soon after the surgery will I be able to resume normal activities, such as driving or working?
Are there any specific questions or concerns you recommend I discuss with the retinal surgeon before the surgery?
Reference
Authors: Ramamurthy S, Raval V, Ali H, Tyagi M, Narayanan R, Reddy R, Das AV. Journal: Retina. 2023 May 1;43(5):784-792. doi: 10.1097/IAE.0000000000003720. PMID: 36728871