High Incidence of Contralateral Retinal Detachment in Patients with Giant Retinal Tears: A Retrospective Cohort Study

PURPOSE: Giant retinal tears (GRTs) pose a threat to vision, and contralateral retinal detachment can have a significant burden on the patient and remains a major concern. We investigated the natural history of the fellow eye, the effectiveness of prophylactic laser treatment, and risk factors for contralateral detachment. SETTING: Retrospective cohort study at Sheba Medical Center, a tertiary referral hospital. METHODS: Seventy-seven patients with non-traumatic, non-syndromic GRTs who underwent surgical repair were followed for contralateral retinal events. Prophylactic laser was offered for contralateral eyes based on physician recommendation and patient consent. Demographic, ocular, and surgical outcomes were analyzed using paired t-tests, Pearson's Chi-square tests, and logistic regression. RESULTS: Retinal tears occurred in 44.2% (34/77) of contralateral eyes, with 33.8% (26/77) progressing to detachment or GRTs. Prophylactic 360° laser was performed in 15.6% (12/77), but no significant difference in detachment rates between treated eyes and untreated eyes (33.3% vs. 33.8%, P = 0.972). No significant associations were found with age, axial length, or refraction. CONCLUSIONS: Despite excluding syndromic patients, we observed a high incidence of contralateral detachment in GRT patients. A two-line anterior 360° Prophylactic laser, as currently applied at our institute, showed no protective effect, suggesting that if applied, a more aggressive approach is needed. While treating 3-4 patients might prevent one detachment, meaningful prevention likely requires more extensive and denser treatment. Prospective evaluation of protocols defined by anatomical landmarks is warranted to establish the optimal technique and risk-benefit balance. Close monitoring remains essential allowing safer, more effective interventions.