Session Title: Vitreoretinal Surgery IV
Session Date/Time: Sunday 20/09/2015 | 09:00-10:30
Paper Time: 10:12
First Author: : O.Okonkwo NIGERIA
Co Author(s): : A. Hassan O. Oderinlo A. Ijasan A. Ogunro M. Ulaikere
PURPOSE:To report the presentation of giant tear retina detachment, surgical technique and outcomes of vitrectomy surgery with silicon oil endotamponad for the repair of retinal detachments arising from a giant retina tear.
All patients were seen, assessed and had vitrectomy surgery at the Eye Foundation Retina Institute.
A retrospective review of a consecutive series of 39 eyes of 39 patients who were noted to have undergone vitrectomy with silicon oil endotamponad for the repair of a giant retina tear retina detachment was done. Of this number, the information in the records was incomplete for 3 eyes, these were excluded from the study. Most of the patients, twenty-two in all were within the 40 to 59 year age bracket. M:F ratio 5:1. Right eye 13, left eye 23. Most of the patients had visual acuity of CF: 15 eyes and HM: 15 eyes. There was a cataract in 21 eyes. The retina was rolled over in 22 of the 36 eyes and the retina detachment was a total retina detachment in 20eyes. The etiology was idiopathic in 21eyes, myopia in 7eyes and related to trauma in 8 eyes. Significant PVR (C and D) was seen in 83% of eyes and giant tear size between 90 – 180 degrees predominated, seen in 20 eyes. The macular was involved in 34 eyes and only one eye had a prior vitrectomy.
Single surgery was done in 20 eyes and two surgeries in 16 eyes. The single operation reattachment rate was 50%, and final reattachment rate after a second surgery was 86%. The reoperation rate was 44%. The visual outcome was not as good as the anatomical outcome; though 10 eyes were noted to have a visual acuity of 6/60 and better against 4 eyes preoperatively. In the 9 eyes in which an encirclement scleral buckle was added the detachment rate was 67% whereas the detachment rate in the no scleral buckle group 27eyes was 44%. The retina attachment rate was higher in the no scleral buckle eyes, when compared with the scleral buckle group. A large percentage of the fellow eyes (47%) were blind. Other issues relating to giant retina tear retina detachment surgery, with reference to posterior slippage and macular ectopia are also discussed.
In our experience, giant tears present late with a high incidence of advanced PVR. It is more likely to be a total retinal detachment with macular involvement, and size of the tear be between 90 to 180 degree. Also, though the retina can be successfully reattached the visual outcome may not represent the anatomical success. The value of a scleral buckle in improving anatomical success in this category of detachment could not be confirmed by this study.