Characteristics of Giant Retinal Tear
•GRT is a full-thickness retinal break, which extends circumferentially for more than or equal to 3 clock hours (≥90°) in the presence of a PVD
RISK FACTORS:
•Closed globe trauma
•Open globe trauma
•Cataract surgery
•Vitrectomy
•Refractive Surgery
•Myopia
•Hereditary vitreoretinopathies
•Buphthalmos & Microspherophakia (Rare)
SPECIAL CHARACTERISTICS:
1) Can rapidly lead to extensive RD
2) Posterior flap has a tendency to roll over, fold or invert,
3) Increased risk of PVR
4) Require meticulous surgery to prevent complications
5) Can have several ocular and systemic associations
6) Fellow eye involvement occurs frequently
7) Re-detachments occur frequently
DIAGNOSIS:
1) CLINICAL:
•Tobacco dusting in vitreous cavity is present in all cases
•Vitreous hemorrhage if tear involves the retinal vessels
•Most GRTs have less than 180 degree circumferential extent
•Location of GRT varies with infero-temporal and supero-nasal quadrants being commonly involved in traumatic cases
•Fundus of the fellow eye should be examined thoroughly to look for any predisposing lesion and features of high myopia
2) B-Scan: 'Double linear echo' sign is seen in GRT with two high-amplitude linear echoes, one extending from the optic disc and other usually lying almost parallel to it with PVD and inverted posterior flap
MANAGEMENT:
•The surgical principles involved in the management include complete vitrectomy, unfolding of the retinal flap, sealing the tear with chorioretinal adhesion and providing long term intraocular tamponade
•PPV + PFCL to flatten the retina followed by endo cyclophotocoagulation and tamponade with silicon oil/ gas
Image from Rajan Eye Care Hospital
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