Surgical outcomes of retinal detachment due to giant retinal tear and utility of fellow eye prophylaxis: a multicenter study

PURPOSE: To compare 6-month single-surgery anatomic success (SSAS) in eyes with giant retinal tear (GRT)-related retinal detachment (RD) treated with pars plana vitrectomy (PPV) with or without scleral buckle (SB), and to assess whether prophylactic fellow eye treatment reduces long-term GRT or RD risk. METHODS: Retrospective multi-center study of eyes with GRT-related RD with ≥6 months follow-up. The primary outcomes were 6-month SSAS after GRT repair and rates of fellow eye GRT and RD. Group differences were assessed with standard univariate tests and logistic regression models. RESULTS: Among 379 eyes of 374 patients with GRT-related RD, PPV/SB was performed in 48.4% and PPV alone in 46.3%. In phakic eyes, higher 6-month SSAS was achieved in the PPV/SB vs PPV group (95.4% vs 83.1%, P=0.005), while in pseudophakic eyes, this PPV/SB benefit was not seen (85.7% vs 84.3%, P=0.82). Proliferative vitreoretinopathy (42.6%) and new retinal tears (22.2%) were the leading causes of re-detachment. Subsequent fellow eye GRT occurred in 5.5% and non-GRT RD in 9.2%. Most patients did not receive prophylactic fellow eye treatment: 7.7% underwent 360° laser and 20.0% received targeted laser. Over a mean follow-up period of 2.8 years, the rates of GRT and RD were similar among fellow eyes treated with circumferential, targeted, or no laser (P ≥ 0.11). CONCLUSIONS: Both PPV/SB and PPV achieved high rates of SSAS after GRT-related RD. PPV/SB should be considered particularly in phakic eyes. Prophylactic laser did not decrease the risk of fellow eye GRT or RD over this follow up period.