Background To compare the outcome of eyes with a macula-on giant retinal tear (GRT) detachment treated with
pars-plana-vitrectomy (PPV) depending on the used endotamponade.
Methods All consecutive cases with a macula-on GRT-associated rhegmatogenous retinal detachment
(RRD) managed with PPV between 2007 and 2022 were retrospectively assessed depending on the selected
endotamponade. By reviewing medical charts and surgical protocols the pre- and intraoperative parameters were
analysed in detail. The number of vitreoretinal (VR) procedures needed for reattachment, the redetachment rate and
the functional outcome were evaluated. Eyes treated with primary silicone oil (SO) tamponade were compared to
eyes with primary gas tamponade. Cases with pre-existing conditions affecting outcome e.g. macula-off situation,
history of trauma, status after complicated cataract surgery, former VR surgery or proliferative vitreoretinopathy grade
C or higher were excluded.
Results Overall, 51 eyes of 45 patients with a macula-on GRT detachment were treated with PPV and SO (n = 32;
63%) or gas (n = 19; 37%) endotamponade in the observed period. Eyes with primary SO tamponade underwent on
average 2.3 (SD 0.8) VR procedures and had a redetachment rate of 13% (n = 4). Eyes with gas tamponade showed
a higher redetachment rate of 32% (n = 6) with a mean number of 1.6 (SD 1.0) PPV procedures. Postoperative bestcorrected
visual acuity (BCVA) was significantly better in eyes with primary gas tamponade (mean logMAR BCVA 0.32;
SD 0.30) compared to eyes with SO (mean logMAR BCVA 0.60; SD 0.42; p = 0.008).
Conclusions Surgical management of GRT-associated RRDs is complex. In clinical routine often SO is used as
endotamponade. Because of known disadvantages (second procedure necessary for SO removal, unexplained
SO-related visual loss, secondary glaucoma, SO emulsification) some VR surgeons prefer a gas tamponade. In
our cohort, eyes with a gas compared to SO tamponade showed higher redetachment rates. However, the final
postoperative BCVA was significantly better in eyes with gas compared to SO tamponade.