Giant Retinal Tear: Definition and Key Features
A giant retinal tear is defined as a full-thickness circumferential retinal break extending 90 degrees (3 clock hours) or more around the retina in the presence of a posteriorly detached vitreous. 1, 2, 3
Defining Characteristics
Size Criterion
- The tear must extend circumferentially for at least 90 degrees (3 or more clock hours) to meet the definition of a giant retinal tear 1, 2, 3
- Most giant retinal tears are less than 180 degrees (76% of cases), though they can extend up to 340 degrees 3, 4
Essential Anatomic Feature
- Posterior vitreous detachment must be present for the diagnosis—this distinguishes giant retinal tears from other types of retinal breaks 1, 2, 3
- The tear represents a full-thickness neurosensory retinal break 3
Clinical Features and Epidemiology
Demographics
- Giant retinal tears comprise only 1.5% of all rhegmatogenous retinal detachments 1, 3
- Strong male preponderance with 72% occurring in males 1
- Average age of incidence is 42 years 1
- Population incidence is approximately 0.05 per 100,000 individuals 1
- Bilaterality occurs in 12.8% of cases 3
Associated Risk Factors
- Ocular trauma is a major causative factor 1
- High myopia 1, 3
- Aphakia and pseudophakia 1
- Hereditary vitreoretinopathies 3
- Genetic mutations involving collagen 1
- Young age 1
- Most cases are idiopathic 3
Clinical Significance
Visual Morbidity
- Giant retinal tears cause significant visual morbidity from retinal detachment and proliferative vitreoretinopathy 2
- Even with successful anatomic reattachment, visual recovery may be limited 3
- In surgical series, postoperative visual acuity better than 20/400 was achieved in only 52% of cases 4
Fellow Eye Risk
- The fellow eye has an increased risk of developing a giant retinal tear, retinal detachment, or both 2, 3
- This elevated risk warrants careful monitoring, though prophylactic treatment efficacy remains unproven 2, 3
Management Complexity
- Giant retinal tears pose significant challenges due to high risk of intra- and postoperative complications 1
- Modern surgical techniques achieve retinal reattachment in 88-100% of cases 1, 3
- Primary reattachment rates of 88% and final reattachment rates of 95% are reported with current vitrectomy techniques 3