13.1 Features
Giant retinal tears (GRTs) are full-thickness breaks in the retina extending for more than 3 clock hours (▶ Fig. 13.1). Patients with a GRT present with symptoms associated with the corresponding retinal detachment. GRTs can be quite large and may even extend for 360 degrees. The risk of proliferative vitreoretinopathy (PVR) is increased in the setting of GRT due to greater access of retinal pigment epithelial cells to the vitreous cavity; extensive membranes can form on both sides of the retina. Diffuse proliferation may result in a closed-funnel configuration because of unrestrained contraction of the large retinal flaps.
Fig. 13.1 (a) Ultra-widefield photograph demonstrating giant retinal tear (GRT) with macula involving retinal detachment and (b) high-magnification view of the edge (arrows) of the GRT extending for approximately 5 to 6 clock hours.
13.1.1 Common Symptoms
Floaters, photopsia, and peripheral visual field cuts that can progress to central vision loss.
13.1.2 Exam Findings
It is important to differentiate GRTs from retinal dialyses due to differences in pathogenesis with implications for surgical management. The posterior flap of the tear in a GRT has a tendency to fold over in a “taco formation” because of the associated posterior vitreous detachment (PVD), especially if the GRT extends near 180 degrees in circumference. Retinal tissue is present anterior to the GRT location. A retinal dialysis, on the other hand, is most often associated with blunt trauma and the retinal break occurs at the ora serrata with an avulsed vitreous base. The posterior flap in a dialysis does not typically fold over and may be relatively immobile due to the overlying vitreous base. There is no retinal tissue anterior to the retinal break in a dialysis due to its location at the ora.
The configuration of GRTs and extent of the associated retinal detachments vary widely. Larger tears result in more rapidly spreading retinal detachments due to easier access of fluid to the subretinal space. Radial extensions (horns) can occur at the edges of the GRT, and the resulting retinal flap may have a higher tendency to fold over. Radial tears are more likely to be associated with vitreous hemorrhage due to larger retinal vessels in their path.
13.2 Key Diagnostic Tests and Findings
13.2.1 Optical Coherence Tomography
Optical coherence tomography (OCT) is generally not necessary but may provide information regarding macular status. OCT may also facilitate identification of retinal inversion in cases of significant retinal folding (▶ Fig. 13.2).
Fig. 13.2 Optical coherence tomography of a giant retinal tear folded over (i.e., inverted) showing the photoreceptor layers toward the top of the image and the inner retinal layers at the bottom of the image due to the inverted retinal flap.
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