Treatment for retinal detachment with giant breaks

Objective To explore the therapeutic effects of micro-vitreoretinal surgery for retinal detachment with giant breaks,as well as the way to improve its curative effect.Methods A retrospective survey was done in 50 eyes with retinal detachment with giant breaks who underwent complete vitrectomy combined with intraocular tamponade.Among them,36 eyes were diagnosed as giant retinal tear(GRT),14 eyes were giant dialysis(GD).Twenty-six eyes were poured with silicone oil,24 eyes were filled with C3F8,14 eyes were applied 360° peripheral retinal photocoagulation.Six eyes were placed encircling buckles.Results The retinae were completely reattached in 49 eyes(98.0%).Thirty-nine eyes were followed up for 6 to 36 months,30 eyes(76.9%) of which remained retinal reattachment and 37 eyes(94.9%) remained retinal reattachment at last.No significant difference was found between the two groups of GRT and GD(P0.05).Postoperational complication included macular epiretinal membrane in 2 eyes,epiretinal membrane in 4 eyes and retinal tears in 2 eyes.Conclusions The failure of this kind of operation was mainly due to an inferior proliferative vireoretinopathy(PVR) and a secondary reopening of the inferior end of the GRT.To improve the therapeutic efficacy,the complete vitrectomy was recommended including removing the vitreous base and excision of the epiretinal and subretinnl membrane.In the case of150° inferior GRT or anterior PVR before operation,a simultaneous encircling buckle is recommended.The 360° peripheral retinal photocoagulation appears to be an effective way to reduce the risk of secondary tearing of the retina after the operation.