This is a video shaded by Dr. Abdellah Zadnass from Agadir Morocco

Giant retinal tear is defined as a tear extending 90º or more around the circumference of the globe.

Unlike the dialysis, in the GRT, the vitreous remains strongly attached to the anterior margin of the flap, and a posterior vitreous detachment is present.

Because of marked retinal mobility, the vitreous removal should be performed using high cut rates and low vacuum. Additionally, the vitreous must be trimmed to the anterior retinal surface and away from the anterior flap to prevent vitreous entrapment and to allow subretinal fluid drainage.

In this case the surgeon used triamcinolone to check the posterior vitreous detachment and no areas of vitreoschisis or epiretinal membranes were evidenced.

Prophylactic ILM peeling is still controversial in these cases. Although it may prevent ERM formation postoperatively, ILM peeling can be challenging in the presence of a detached retina and especially in the presence of a detached macula. Inadvertent trauma during peeling may offset the potential beneficial effect of preventing future macular pucker.

However, some studies have proposed preventive peeling in complicated cases with PVR, and large or giant retinal tears, and those undergoing silicone oil tamponade. These studies have described low risk and lower ERM formation rates in the postoperative period.

It's important to try to inject PFCL in a single bubble. In case of multiple bubbles formation, they have to be aspirated or transformed in a single one, before it reaches the flap margin. This way you can avoid subretinal PFCL migration.
The heavy liquid unflod the flap margin, removes the subretinal fluid and enables stabilization of the retina and close trimming of the peripheral vitreous base, especially at each end of the tear. Then, endolaser is performed in the periphery for retinopexy.
A critical point in this surgery is the fluid air exchange. Careful removal of the anterior fluid should be done, otherwise anterior residual fluid may cause detachment or retinal slippage.
In the end of this procedure, silicone oil was used as a tamponade agent. Then the cannulas were removed and scleraconjunctival Vycril sutures were made.

Video
Abdellah Zadnass MD
Agadir - Morocco 🇲🇦
Edition:
Filipe Lucatto MD
Juliana Prazeres MD
Salvador 🇧🇷

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