The evolution of the management of GRT

October 1, 2013

During the advent of surgical approaches for retinal detachment repair, one of the most challenging cases a retinal surgeon may come across was a giant retinal tear. This article summarizes the history of GRT management and discusses current trends in surgical management.

The management of GRTs has evolved considerably over the decades. Early surgical techniques such as intraocular balloons (1970s), rotating tables and retinal incarceration with tacks, sutures and screws (1980s) have evolved into small gauge pars plana vitrectomy (PPV), wide field viewing systems and intraoperative perfluorocarbon liquid (PFCL) use. This article will briefly summarize the history of GRT management and discuss current trends in surgical management.

History of GRT management

Success rates in the management of GRTs are associated with the ability of the surgeon to manipulate the retinal flap back into its original configuration and maintain its position with intraoperative and postoperative tamponade. Earlier attempts were limited by an inability to effectively achieve and maintain the proper position of the retinal flap. A primary encircling scleral buckle could be successful in cases of minimally displaced GRTs with the placement of a low broad based scleral buckle. In the early 1980s, with the evolution of vitrectomy techniques, the surgeon could manipulate the GRT intraoperatively with rotating tables and intraocular gas tamponade.