ANATOMICAL OUTCOMES AFTER TRAUMATIC GIANT RETINAL TEAR (GRT) ASSOCIATED RETINAL DETACHMENTS REPAIR.

Abstract

ABSTRACT: PURPOSE: To analyze the surgical outcomes of giant retinal tear (GRT) associated retinal detachments and their association with extent of giant retinal tear (GRT), grade of proliferative vitreoretinopathy (PVR) and type of surgical procedure performed. MATERIALS AND METHODS: A retrospective case analysis of 150 eyes, conducted at Lahore General Hospital’s ophthalmology department from 2003 and 2018. The research included patients who underwent different types of surgical repairs for GRT associated detachments. The data was divided into four groups based on the type of surgical procedures performed and the time period. Patients who underwent encirclement with 20-gauge pars plana vitrectomy and 1000 centistokes silicone oil for surgical repair between 2003 and 2008 were classified as Group A. This included 36 (24%) eyes out of the total. In 10 (27.78%) eyes the extent of giant retinal tear was equal to or greater than 180 degrees and in 26 (72.22%) eyes the extent of giant retinal tear was less than 180 degrees. Patients operated between 2009 and 2013 were classified into Group B and C differing in the surgical technique employed for repair during this time period. Those who underwent encirclement with 23-gauge pars plana vitrectomy and 5000 centistokes silicone oil for surgical repair were classified as Group B. This included 39 (26%) eyes and the extent of GRT was less than 180 degrees in all 39 (26%) eyes. Patients who underwent correction with 23-gauge pars plana vitrectomy and 5000 centistokes silicone oil for surgical repair were classified as Group C. It included 13 (8.67%) eyes and the extent of GRT was equal to or greater than 180 degrees in all eyes operated. Patients who underwent surgical repair with 23-gauge pars plana vitrectomy and 5000 centistokes silicone oil between the year 2014 to 2018 were classified as Group D. It included 62 (41.33%) eyes, 16 (25.81%) eyes had extent of giant retinal tear equal or greater than 180 degrees and 46 (74.19%) eyes had extent of giant retinal tear less than 180 degrees. In all the groups the patient's demographic profile was recorded along with extent of GRT, grade of proliferative vitreoretinopathy and the surgical procedure employed for correction. The follow up period of the patients extended from 5 months to 7 years. RESULTS: The data included 150 patients out of which 95 were males and 55 females who were followed up after the surgery from 1 year to 7 years post-operatively. Out of 150 eyes, 39 (26%) eyes had the extent of giant retinal tear equal to or greater than 180 degrees and 111 (74%) eyes had extent of giant retinal tear less than 180 degrees. Amongst the patients 48 (32%) eyes were phakic, 75 (50%) were pseudophakic and 27 (18%) were aphakic. Five eyes (3.33%) had a proliferative vitreoretinopathy grade A, 34 (22.67%) eyes had proliferative vitreoretinopathy grade B while proliferative vitreoretinopathy grade C was noted in 111 (74%) eyes. In group A, primary success was achieved in 20 (55.56%) eyes out of 36 while 16 (44.44%) eyes had re-detachment for which they had repeated surgery. After revision surgery there was retinal attachment in 12 (75%) eyes while 4 (25%) cases remained unsuccessful. In group B 30 (76.92%) had attached retina after primary surgery while 9 (23.08%) eyes had second surgery with 8 (88.89%) eyes achieving retinal attachment while 1 (11.11%) remained persistently detached. In group C, the retinal flattening was achieved in 7 (53.85%) out of 13 eyes. Revision surgery was successful in all the 6 (100%) eyes. In group D, 56 (90.32%) out of 62 eyes had primary successful surgery. 6 eyes had revision surgery with a 100% success rate. In total out of 150 eyes operated in 113 (75.33%) eyes primary surgical repair was successful while 37 (24.67%) eyes had recurrent retinal detachment. These 37 cases had surgical revision procedure performed. 145 (96.67%) eyes had anatomically attached retinas on follow-ups. Conclusion: Primary and revision GRT associated retinal detachments with varying grades of PVR achieved high success rates of retinal attachments after undergoing surgical correction with various methods of surgical treatment. Keywords: Proliferative vitreoretinopathy, Giant retinal tear (GRT), Pars plana vitrectomy, Silicone oil.