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    Managing challenges in giant retinal tear re-attachment

    Giant retinal tears pose outsize challenges for physicians, including the risks of hemorrhage, heavy fluid droplets, and macular holes, according to Gerardo Ledesma-Gil, MD, who was challenged with both of these complications in a recent case.

    Mexico City—Giant retinal tears pose outsize challenges for physicians, including the risks of hemorrhage, heavy fluid droplets, and macular holes, according to Gerardo Ledesma-Gil, MD.

    Dr. Ledesma-Gil, a retina fellow at the Instituto de Oftalmología Fundación Conde de Valenciana in Mexico City, Mexico, presented his team’s experience during Retina Subspecialty Day at the 2015 meeting of the American Academy of Ophthalmology.

    “These surgeries are complicated and you have to take your time,” Dr. Ledesma-Gil said. “If something goes wrong, be calm and make another plan.”

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    Video courtesy of Gerardo Ledesma-Gil, MD

    Giant retinal tears are rare, Dr. Ledesma-Gil pointed out.

    In 2010, the British Giant Retinal Tear Epidemiology Eye Study (Invest. Ophthalmol. Vis. Sci. 2010;51(9):4781-4787) found an incidence of 0.094 retinal tears per 100,000 people. Although retinal attachment was achieved in 94.7% of patients, only 42.1% achieved vision of 20/40 or better.

    Dr. Ledesma-Gil’s patient was a 29-year-old man who underwent phacoemulsification in 2009 as treatment for injuries from blunt trauma to the eye.

    Five years later, the man presented with a giant retinal tear and retinal detachment. The surgeons began their treatment with PPV. They used perfluorocarbon heavy liquid to flatten the retina, allowing them to observe its anterior edge.

    After an air fluid exchange, they tried to reattach the anterior edge. During this procedure, a subretinal hemorrhage occurred. However, the surgeons were able to control it and remove all the clots.

    “I think in that part of the surgery the heavy liquids came under the retina incidentally,” Dr. Ledesma-Gil said.

    When the surgeons noticed the heavy liquid under the retina, they drained it surgically and performed another air fluid exchange.

    Using an endoprobe to deliver laser, they reattached the retina, then infused silicone oil as a long-acting tamponade.

    During a follow-up

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