Giant retinal tears – size does matter

Losing vision constantly ranks among the top three worst health issues, together with cancer and Alzheimer disease, when surveyed among the general public. One of the acute disorders that poses a threat to vision and requires immediate surgical intervention, is rhegmatogenous retinal detachment. It is the most common type of retinal detachment and is caused by a defect in the retina, usually small retinal tears. However, approximately 2% of patients have a ‘giant retinal tear’, defined as a retinal break in at least one quarter (90 degrees) of the retina. Surgical treatment for patients with a giant retinal tear is less successful compared to retinal detachment caused by smaller retinal defects. Therefore, patients with a giant retinal tear are at profound risk for visual impairment.

Birgit Govers, a PhD candidate under the supervision of Jeroen Klevering (Head of the Ophthalmology Department), delved into characteristics, management and post-operative outcome of GRT patients. In this extensive retrospective cohort study, they analysed 222 eyes of 206 patients and aimed to identify risk factors for detachment in the fellow eye. One-third of giant retinal tear patients developed a retinal detachment in the fellow eye, resulting in severe risk of visual impairment in both eyes. Due the substantially high risk for retinal detachment in both eyes, prophylactic laser photocoagulation for the fellow eye is currently recommended for all GRT patients, ideally within one month. Clinical parameters showed limited predictive value for a retinal detachment in the fellow eye. In contrast, clinical parameters such as myopia significantly contribute to the fellow eye’s risk in small retinal tear detachments. Several remarkable findings led to the hypothesize of a strong genetic contribution to the giant retinal tear risk. Understanding these potential genetic factors may contribute to the identification of patients at risk.

Read the study here.