A 62 year old man presented to clinic with 4 days of a veil progressing over the inferior portion of his visual field. There was no associated pain or flashing lights.
Past Ocular History
History of uncomplicated cataract surgery in the left eye with posterior chamber lens in place. Cataract right eye.
VA was 20/20 right eye and count fingers at 4 feet left eye. IOP was 22 and 16mmHg, respectively. The anterior exam was unremarkable and showed mild nuclear sclerotic cataract in the right eye and a posterior chamber lens in the left eye.
The posterior exam was notable for the findings below in the left eye:
- Giant Retinal Tear
- Associated with
- Marfan syndrome
- Stickler syndrome
- High myopia
- Broken capsule in cataract surgery
- Pneumatic retinopexy
- Retinal dialysis
Based on appearance and history of the diagnosis of giant retinal tear was made. The patient was taken to the OR for scleral buckle, vitrectomy, endolaser and gas which resulted in successful retinal reattachment.
Giant retinal tears are defined as a retinal tear affecting greater than 90 degrees of the retina. Although associated with connective tissue disorders such as Sticker syndrom, Ehlers-Danlos syndrome and Marfan Syndrome, and risk factors such as high myopia, over half of cases are idiopathic. Males are more often affected than females (70% vs 30%). Giant tears provide a surgical challenge, as the retina may be prone to folding and slipping. There is a substantial risk of proliferative vitreoretinopathy for these patients compared to a typical retinal detachment. There is also some debate among retinal specialists about the use of scleral buckles for giant retinal tear related detachments.
Retina, 5th edition, Ryan et al.2013, Chapter 109, 1844-1851