Interventions for prevention of giant retinal tear in the fellow eye

A giant retinal tear is a full-thickness retinal break that extends for 90 degrees or more around the circumference of the retina, in the presence of posterior vitreous detachment (when the vitreous comes away from the retina). Giant retinal tears cause visual loss as a result of the associated retinal detachment. They can be difficult to treat due to the large area of retinal involvement and the high risk of re-detachment following vitreoretinal surgery, often related to the development of proliferative vitreoretinopathy (a scarring process that can happen on the inner or outer surface of the retina and in the vitreous cavity after retinal detachment). As the fellow eye has an increased risk of developing giant retinal tear and retinal detachment, prophylactic 360-degree treatments with laser photocoagulation, cryotherapy or encircling scleral buckling have been proposed to reduce this risk. This review did not find any strong evidence in the form of prospective randomised controlled trials or case-control studies to support or refute these prophylactic treatments.

Authors' conclusions: 

No strong evidence in the literature was found to support or refute prophylactic 360-degree treatments to prevent a giant retinal tear or a retinal detachment in the fellow eye of patients with unilateral giant retinal tears.

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Background: 

A giant retinal tear is a full-thickness retinal break that extends circumferentially around the retina for 90 degrees or more in the presence of a posteriorly detached vitreous. It causes significant visual morbidity from retinal detachment and proliferative vitreoretinopathy. The fellow eye of patients who have had a spontaneous giant retinal tear has an increased risk of developing a giant retinal tear, a retinal detachment or both. Interventions such as 360-degree encircling scleral buckling, 360-degree cryotherapy and 360-degree laser photocoagulation have been advocated by some ophthalmologists as prophylaxis for the fellow eye against the development of a giant retinal tear and/or a retinal detachment, or to prevent its extension.

Objectives: 

To evaluate the effectiveness of prophylactic 360-degree interventions in the fellow eye of patients with unilateral giant retinal tear to prevent the occurrence of a giant retinal tear, a retinal detachment or both.

Search strategy: 

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 11), MEDLINE (January 1950 to December 2011), EMBASE (January 1980 to December 2011), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to December 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 6 December 2011. In addition, we searched the proceedings of the Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) up to 2008 for information about other relevant studies.

Selection criteria: 

Prospective randomised controlled trials (RCTs) comparing one prophylactic treatment for fellow eyes of patients with giant retinal tear against observation (no treatment) or another form of prophylactic treatment. In the absence of RCTs, we planned to discuss case-control studies that met the inclusion criteria but we would not conduct a meta-analysis using these studies.

Data collection and analysis: 

We did not find any studies that met the inclusion criteria for the review and therefore no assessment of methodological quality or meta-analysis could be performed.

Main results: 

No studies met the inclusion criteria for this review.

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