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Retinal Case of Interest: Giant Retinal Tear

Patient History

Wide angle image of a giant retinal tear.A 50 year old male presented to the clinic with a 3 month history of 'cloudy vision', flashing lights and floating objects in the left eye. Recently, he had noticed a black diagonal shadow moving across the left eye and had difficulty reading.

His visual acuity was 6/6 in the right eye (100% normal vision) and 6/60 in the left eye (10% of normal vision). When examined, a left 'Giant retinal tear' with retinal detachment involving the macula was evident.

He was taken to the operating theatre within the hour where the retina was unfolded and repositioned using heavy liquid. Laser treatment was applied to the tear to 'spot weld' the retina tear and detachment to help keep it in position. Visual acuity in the eye had improved to 6/15 (40% of normal vision) 5 weeks following the operation.
 

Figure 1: OPTOS photo (wide angle imaging) of a giant retinal tear and detachment involving over 25% of the retina (11 to 3 o'clock) with part of the retina folding onto itself.


What is a giant retinal tear?

A large break involving at least one quarter of the retina (3 clock hours).


How common is this condition?

Approximately 25 patients per year in Australia will develop such a tear, and it accounts for 1 in every 200 retinal detachments.


Who is more likely to develop a giant retinal tear?

Patients who are very near sighted (myopic), have Stickler's Syndrome, or a previous history of retina tear or detachment.

 
What can this condition lead to?

If untreated, it can develop into a retinal detachment, leading to the rapid loss of central vision and legal blindness.


Is a giant retinal tear related to trauma?

Yes, but only in 20% of cases; most giant tears occur without a clear cause.
 

Wide angle image after surgery to repair a giant retinal tear.

Figure 2: OPTOS photo (wide angle imaging) following surgery showing the retina back in its usual position, with laser burns (yellow dots).