Retinal detachment with 360-degree giant tear: How to deal with?

Author: Fehmy Nafaa (Tunisia)

Co-authors: Meriem Ouederni, Ahmed selmi, Cheour monia

Purpose

To describe the management of a total retinal detachment with a 360-degree giant tear. The technique consisted on 23-gauge vitrectomy with close peripheral shave, followed by retinal flattening with perfluorocarbon liquid (PFCL) and direct exchange to silicone oil.

Setting/Venue

Department of ophthalmology of Habib Thameur Hospital in Tunis (Tunisia).

Methods

We present the case of a 34-year-old man with a history of high myopia. He complained about a sudden loss of vision of his right eye evolving for 3 weeks. Visual acuity was limited to light perception in the right eye. Slit lamp examination was unremarkable, IOP was 6 mmHg, fundoscopy showed pigment in the vitreous cavity (3+), a total retinal detachment with a crumpled retina associated to a 360-degree giant tear. Best corrected visual acuity (BCVA) of the left eye was 20/60 (-8,00) and ophthalmic examination was normal. The patient underwent 23-gauge vitrectomy. We started with central and peripheral vitrectomy assisted by triamcinolone acetonide for posterior vitreous hyaloid removal. Close vitreous shave was performed with excision of the residual retinal tissue. PFCL was gently injected over the optic disc and extended peripherally until the retina was totally flattened. Then we performed 360-degree retinopexy with endolaser photocoagulation. Silicone oil was injected trough the infusion terminal to facilitate direct exchange PFCL to silicone oil and to prevent retinal slippage. Sclerotomies were sutured after trocars removal.

Results

Two months postoperatively, BCVA of the right eye was 20/400 (+4,00), IOP was 18 mmHg with monotherapy (Topic Timoptol). Slit lamp examination showed clear lens. On fundoscopy, the retina was totally attached. We decided to delay silicone oil removal 4 months after surgery.

Conlusions

Retinal detachment with a 360-degree giant tear is a very rare condition. Its surgical management remains challenging. It requires a complete vitrectomy and excision of residual retinal tissue to prevent postoperative vitreo-retinal proliferation. This could allow a lower rate of recurrent retinal detachment after silicone oil removal.

Financial Disclosure

No Financial discloser