Giant Retinal Tears

Preventing Giant Retinal Tears
November 6, 2013
Annual AAO Meeting and Young Ophthalmologists
December 3, 2013
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Giant Retinal Tears

I fix giant retinal tears in stages.

Giant retinal tears (GRT) are a specific type of retinal detachment.  They are noteworthy for often causing legal blindness or worse.  They are particularly difficult to fix despite using traditional techniques such as scleral buckle, vitrectomy, gas, silicone oil, etc.

The following video is a giant retinal tear (GRT) and how I repair using a combination vitrectomy, Perfluoron.  Giant retinal tears are complicated because the retina actually tears or rips as you can see in the video.  This is quite different compared to a rhegmatogenous retinal detachment where fluid simply accumulates underneath the retinal detachment.

With giant retinal tears, the retina often folds over on itself like an omelet.

 

Perfluoron to Repair Giant Retinal Tear

The first step is to remove as much vitreous as possible.  The difficulty is to unfold the retina.  By removing the vitreous, the retina is more likely to unfold.  After the vitreous is removed, I’ll attempt to unfold the retina by using Perfluoron.

Perfluoron is heavier than water.  In the video, I’ll use the Perfluoron as a tool to unfold, or steamroll, the retina back to the proper position.  Once in position, the retina can be treated with laser.  The laser will eventually scar the retina in place…assuming the retina stays in the proper orientation.

It is often not too difficult to unfold the giant retinal tear with Perfluoron.  The difficulty and complications of surgery usually arise in trying to keep the retina unfolded and in its proper place.  Most retina specialists (perhaps all?) remove the Perfluoron, infuse gas or silicone oil and hope that the retina remains unfolded.

Often, this fails leading to repeated or complicated retinal detachments.

Perfluoron Remains in Eye

My preference is to leave the Perfluoron in place for 1-4 weeks to ensure proper reattachment without slipping.

The latter portion of the video demonstrates the second vitrectomy to remove the heavy water.  During a separate operation, the Perfluoron is simply removed, the laser has caused scarring so that the retina can not slip.

What Does this Mean?

By breaking up the reattachment into stages, my success rate has been astounding.  Almost no surgical complications (no reoperations) compared to conventional methods and, most importantly, the visual results have been amazing.

Compliance is also not an issue.  Patients must lie on their back instead of keeping face down compared to face down positioning (when using gas or silicone oil).

While this may be an unconventional way of using Perfluoron, the reduced complications, improved visual results and shorter operating times are certainly reasons to consider operating on giant tears in stages.

Preventing a giant retinal tear from forming is paramount, when possible as these are such nasty types of retinal detachment.

 

 

 

Comments
  • Ignacio D. Espinoza November 19, 2013 at 4:48 pm

    Dr Randall, I applaud your educational efforts by use of the internet. I suffered a retinal detachment with giant tear on my left eye, in Jan 2012. I was operated on Jan 5th 2012. The Doctor performed a vitrectomy and scleral buckle. After surgery I was required to remained face down at all times. I returned to work after 30 days, doing physical work. On March 7th 2012 I returned to see my Doctor on an emergency basis because everything went dark in my eye. My Doctor informed me that the surgery failed and the retina detached again. Doctor proceeded to inflate my eye with gas and ordered me to remain inactive and face down for 24 hours. One week later he bombarded my eye with laser to re-attach the retina. He went on to refill my eye with gas which stayed on for the rest of 2012.Very painful by the way. I went from seeing colors to seeing nothing in the process.
    The Doctor decided to perform a second surgery, on July 12 of 2012. Doctor stated that scarring had formed on my retina and that it was blocking my vision, and that he needed to get inside the eye once again. I requested at the time to have the lense in my put back in, as he had removed it during the initial surgery back on Jan 5th. After the surgery he informed me that there was some bleeding and that it took him longer that expected, and he decided not to implant a new lense in my eye, instead he re-filled my eye with gas
    Long story short. I have no vision on my left eye, The Doctor tells me that the retina is attached, however there is no eye pressure, the last exam on Oct 7th, 2013 my left eye pressure was 1.0
    It appears that my Doctor does things very different compare to you. Do you have any suggestions for me? I’m willing to travel to Virginia and have you look at my eye. I’m in Orlando, Florida.
    Thank you for your time and sorry for my long message. I would appreciate your suggestions.

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