Systematic review of surgical techniques for treating giant retinal tears in adults: A current assessment of approaches and interventions

Abstract

Giant retinal tears (GRTs) are rare and challenging complications of rhegmatogenous retinal detachment (RRD) that necessitate intricate surgical management. This study aimed to systematically review and analyze the functional outcomes, anatomical success rates, and complications associated with surgical interventions for GRTs in adults. A comprehensive literature search was conducted using electronic databases, including PubMed, Embase, Web of Science, and the Cochrane Library, from 2002 to February 2024. We included original research articles with diverse study designs involving adult patients (≥18 years) who underwent surgical treatment for GRTs. The identified interventions included pars plana vitrectomy, scleral buckling, combined procedures, and pneumatic retinopexy. The outcome measures included detailed descriptions of pre-and post-operative visual acuity, initial and final anatomical success rates, and main post-operative complication descriptions. After screening 4104 records, 22 studies were ultimately included in the study. The total sample comprised 1607 participants, with a male predominance. Surgical interventions have resulted in varying improvements in post-operative visual acuity. Notably, the anatomical success rates ranged from 70% to 100%, with microincision vitrectomy surgery (MIVS) platforms currently being the predominant gold-standard surgical method for GRT-associated RRDs. The postoperative complications identified were proliferative vitreoretinopathy (PVR), epiretinal membrane (ERM) development, hypotony, cataracts, uveitis, and foreign body reaction. Subsequent examination revealed poor pre-operative visual acuity, pre-operative PVR, and younger age, which presented challenges that impacted the outcomes. Despite limited evidence, this systematic review offers valuable insights into the diverse outcomes and difficulties associated with surgical approaches and interventions for GRTs in the adult population. This study highlights the significance of management strategies and calls for additional research in this field.