Surgical techniques for selected giant retinal tears.

Based on clinical experience, improved methods for treating giant retinal tears with an inverted retinal flap are described. In all cases a broad encircling scleral buckle is used in conjunction with a broad zone of peripheral chorioretinal adhesion produced by cryotherapy and, often, supplemented by postoperative photocoagulation. This virtually eliminates recurrent retinal detachment from an anterior location, if the retinal flap can be properly unfolded and the retina is initially reattached. Vitrectomy is done in all these cases, and an intraocular bubble is used to unfold and reposition the retinal flap during or after surgery. If the retinal flap is especially stiff or foreshortened, special techniques are used to incarcerate the edge of the retinal flap in the pars plana or the peripheral choroid, or transvitreal suturing techniques are used to secure the edge of the retinal flap to the eyewall before fluid-gas exchange is performed. This insures proper unfolding of the flap by the intraocular bubble. Applying retinal cryotherapy before performing the vitrectomy seems to reduce the occurrence of postoperative proliferative vitreoretinopathy (PVR), perhaps because retinal pigment epithelial cells in the vitreous cavity are removed during vitrectomy. Frequent, detailed examination during the first three weeks after surgery and use of postoperative photocoagulation to supplement the cryotherapy seem to prevent recurrent detachment from anterior leakage of subretinal fluid beneath the retinal flap or through other anterior retinal breaks.