Surgical outcomes of retinal detachment due to giant retinal tear and utility of fellow eye prophylaxis: a multicenter study.

Abstract

To compare 6-month single-surgery anatomic success (SSAS) in eyes with giant retinal tear (GRT)-related retinal detachment (RD) treated with pars plana vitrectomy (PPV) with or without scleral buckle (SB), and to assess whether prophylactic fellow eye treatment reduces long-term GRT or RD risk. Retrospective multi-center study of eyes with GRT-related RD with ≥6 months follow-up. The primary outcomes were 6-month SSAS after GRT repair and rates of fellow eye GRT and RD. Group differences were assessed with standard univariate tests and logistic regression models. Among 379 eyes of 374 patients with GRT-related RD, PPV/SB was performed in 48.4% and PPV alone in 46.3%. In phakic eyes, higher 6-month SSAS was achieved in the PPV/SB vs PPV group (95.4% vs 83.1%, P=0.005), while in pseudophakic eyes, this PPV/SB benefit was not seen (85.7% vs 84.3%, P=0.82). Proliferative vitreoretinopathy (42.6%) and new retinal tears (22.2%) were the leading causes of re-detachment. Subsequent fellow eye GRT occurred in 5.5% and non-GRT RD in 9.2%. Most patients did not receive prophylactic fellow eye treatment: 7.7% underwent 360° laser and 20.0% received targeted laser. Over a mean follow-up period of 2.8 years, the rates of GRT and RD were similar among fellow eyes treated with circumferential, targeted, or no laser (P ≥ 0.11). Both PPV/SB and PPV achieved high rates of SSAS after GRT-related RD. PPV/SB should be considered particularly in phakic eyes. Prophylactic laser did not decrease the risk of fellow eye GRT or RD over this follow up period.