HIGH INCIDENCE OF CONTRALATERAL RETINAL DETACHMENT IN PATIENTS WITH GIANT RETINAL TEARS: A Retrospective Cohort Study.

PURPOSE: Giant retinal tears (GRTs) pose a threat to vision, and contralateral retinal detachment can have a significant burden on the patient and remains a major concern. The authors investigated the natural history of the fellow eye, the effectiveness of prophylactic laser treatment, and risk factors of contralateral detachment.

METHODS

Seventy-seven patients with nontraumatic, nonsyndromic GRTs who underwent surgical repair were followed for contralateral retinal events. Prophylactic laser was offered for contralateral eyes based on physician recommendation and patient consent. Demographic, ocular, and surgical outcomes were analyzed using paired t -tests, Pearson's Chi-square tests, and logistic regression. This was a retrospective cohort study conducted at Sheba Medical Center, a tertiary referral hospital.

RESULTS

Retinal tears occurred in 44.2% (34/77) of contralateral eyes, with 33.8% (26/77) progressing to detachment or GRTs. Prophylactic 360° laser was performed in 15.6% (12/77), but no significant difference was found in detachment rates between treated eyes and untreated eyes (33.3% vs. 33.8%, P = 0.972). No significant associations were found with age, axial length, or refraction.

CONCLUSION

Despite excluding syndromic patients, the authors observed a high incidence of contralateral detachment in GRT patients. A two-line anterior 360° prophylactic laser, as currently applied at the authors' institute, showed no protective effect, suggesting that if applied, a more aggressive approach is needed. While treating 3 to 4 patients might prevent one detachment, meaningful prevention likely requires more extensive and denser treatment. Prospective evaluation of protocols defined by anatomical landmarks is warranted to establish the optimal technique and risk-benefit balance. Close monitoring remains essential allowing safer, more effective interventions.