This is a case shared by Dr. Melvin Gutiérrez and Dr. Santiago Morales from Barranquilla Colombia

This is a case of Giant Retinal Tear treated with Scleral Buckling and combined phaco/vitrectomy

It was a superior retinal detachment with attached macula in the right eye in a young patient.

To place a Scleral Buckle or not in cases of Giant retinal tear is still a controversial topic. Studies have shown similar postoperative complications, functional or anatomical success rates with both approaches. However, some surgeons prefer to add a SB once it can support the vitreous base, reduce the circumference of the globe and relieve the vitreoretinal traction in the periphery. Furthermore, it can provide an easier shaving of the vitreous base especially in phakic eyes.
It's important to be aware that SB can increase the chance of retinal slippage if it is sutured too tight. It occurs due to a change in ocular contour and scleral shortening relative to retina gaping of retinal tissue.

Heavy liquids are very useful in these cases once it keeps the retinal flap down and helps to remove all the subretinal fluid.

It’s important to perform radical excision, removing as much as possible the vitreous base and also the anterior flap, under scleral indentation.

Another key point of this surgery is to remove all the fibrosed and folded border of the retinal flap.

Then, endolaser is made around the tear.

During fluid-air exchange, you can avoid slippage by thoroughly removing the subretinal fluid before PFCL aspiration. Tilt the eye away from the tear while aspirating the subretinal fluid and when the tear is completely dry, you can remove the remaining PFCL.

Reference:
Ting, D.S.W., Foo, V.H.X., Tan, TE. et al. 25-years Trends and Risk factors related to Surgical Outcomes of Giant Retinal Tear-Rhegmatogenous Retinal Detachments. Sci Rep 10, 5474 (2020). [ Ссылка ]

Author:
Melvin Gutiérrez MD
Santiago Morales MD
Barranquilla - Colombia
Edition:
Filipe Lucatto MD
Juliana Prazeres MD
Salvador - Brazil

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