Introduction

Giant retinal tear (GRT), defined as retinal breaks extending 90 degrees or more circumferentially, is found in a relatively small proportion of patients with primary rhegmatogenous retinal detachment (RRD)1. Population-based studies on GRT-associated RRD (GRT–RRD) showed an annual incidence of 0.09–1.15 per 100,000 individuals, whereas hospital-based data indicated GRT–RRD comprising 0.5–8.3% of all RRD cases2,3. GRT–RRD predominantly affects males and is often idiopathic. Risk factors include ocular trauma, high myopia, hereditary vitreoretinal disorders, and prior eye surgeries. Ocular trauma was particularly noteworthy, contributing up to 40% of GRT–RRD cases in some studies4,5,6,7.

The development of primary GRT–RRD is thought to be caused by vitreous changes. As the vitreous liquefies and separates from the retina, the regions where it is strongly attached to the retina, particularly in the peripheral area with a white without pressure appearance, may be susceptible to traction and subsequent GRT–RRD. Vitreous is mainly composed of extracellular matrix and collagen (particularly type II, V/XI, and XI). Some hereditary disorders related to GRT–RRD involve mutations in collagen-producing genes, such as the COL2A1 and COL11A1 genes in Stickler syndrome and the fibrillin-1 gene in Marfan syndrome, resulting in abnormal vitreous development8,9. In cases of penetrating eye injuries, GRT–RRD may result from direct retinal injury, vitreous incarceration, or fibrous formation in the vitreous10. Non-penetrating eye injuries can cause GRT–RRD through rapid expansion of the circumferential sclera and vitreous, which have distinct elastic characteristics, leading to shearing forces and traction at the vitreous base. This can result in various tissue injuries including vitreous base avulsion (vitreous detaching from its base), retinal dialysis (retina separating from the ora serrata, with vitreous attached to the posterior dialysis edge), and GRT/RRD (vitreous adhering to the anterior break margin, with the posterior margin free of vitreous attachment)11. Additionally, coup and contrecoup effects may cause direct retinal injury, resulting in necrosis, breaks, and detachment, even without vitreous traction12.

Compared to noncomplex RRD patients with smaller retinal breaks, those with GRT–RRD require more complex surgical procedures to unfold the rolled-over large retina flap and limit the occurrence of retinal slippage during retinal flattening procedures13,14,15. Additionally, due to the extensive exposure of the retinal pigment epithelium, these patients face a higher risk of re-detachment, which might be partially attributed to the development of pre- and postoperative proliferative vitreoretinopathy (PVR)16,17,18. Recent research has confirmed a higher re-detachment rate in GRT–RRD patients compared to those with simple retinal detachments19.

Despite these challenges, advances in surgical technology and pars plana vitrectomy (PPV) techniques, such as microincisional vitrectomy systems (MIVS), perfluorocarbon liquid (PFCL), and wide-field visualization systems, have significantly improved the outcomes of PPV for GRT–RRD management20,21,22. MIVS facilitates peripheral vitreous shaving, reduces vitreous traction and iatrogenic breaks, and minimizes vitreous incarceration at the sclerotomy ports23. Perfluorocarbon liquid (PFCL), a high-specific gravity substance, plays a crucial role both intraoperatively and postoperatively. It stabilizes and flattens the detached retina and decreases the risk of posterior retinal flap slippage during surgery. Postoperatively, it can serve as a temporary retinal tamponade for varying durations, ranging from roughly a week for short-term use to 2–3 weeks for intermediate-term treatment. Numerous studies have proved the safety and efficacy of PFCL in complex vitreoretinal surgeries, including GRT–RRD repair24,25,26.

Currently, PPV, with or without PFCL assistance, is the preferred surgical approach for GRT–RRD treatment. However, the benefit of combining scleral buckling (SB) with PPV (PPV/SB) is controversial. Some studies revealed that adding SB–PPV was beneficial, especially in cases where peripheral vitreous removal was difficult to perform, such as in phakic eyes or pediatric patients. Conversely, other studies have found no significant difference in outcomes between PPV alone versus PPV/SB27. This study aims to present the characteristics, anatomical outcomes, and visual outcomes of patients with non-traumatic and traumatic-related GRT–RRD who were treated at a tertiary referral center in Northern Thailand.

Methods

This study was a retrospective, comparative, non-randomized, observational case series. The procedures conducted in this study adhered to the tenets of the Declaration of Helsinki. The protocol (study code: OPT-2564-08508) received approval from the ethics committee of Chiang Mai University Hospital. Additionally, since there was no direct patient contact, a waiver of informed consent was granted. All consecutive patients undergoing primary RRD repair between January 1, 2013, and December 31, 2021, were extracted from the hospital's operating list. Two of the authors, (JC and PR) reviewed patients' medical records, surgical notes, and available fundus photographs to confirm study eligibility, which required a retinal tear extending circumferentially 90 degrees or more. In conditions of diagnostic uncertainty, DP provided the final decision. Exclusion criteria included patients who had a history of open globe injury, concurrent retinal vascular diseases, vitreoretinal inflammation, prior vitreoretinal surgery, or those who did not attend at least one follow-up appointment after the surgeries. The medical charts were reviewed to gather information on patients' demographics, clinical signs and symptoms, ocular characteristics, details of surgical procedures, and surgical outcomes. In cases of bilateral RRD, the eye repaired first was included. All data were recorded in a Microsoft Excel spreadsheet and deidentified for statistical analysis.

During the study period, all patients diagnosed with GRT/RRD underwent a 3-port 23-gauge PPV as an initial operation. The procedure included core vitrectomy and peripheral vitreous base shaving. In cases where the lens impeded adequate visualization of the posterior segment or obscured peripheral shaving, a combined PPV with lensectomy was performed. Other surgical approaches varied based on the surgeon's discretion which included PFCL assistance, supplementary scleral buckling, cryoretinopexy to the GRT edge, and the choice of endotamponade (expansile gas, silicone oil, or PFCL). Endolaser photocoagulation was consistently applied along the posterior retinal flap in all cases. When supplementary scleral buckling was deemed necessary during the primary surgery, it was gently performed after the detached retina had been flattened. In cases where PFCL was used as a postoperative tamponade, it was left in place for a short duration of 7–10 days before removal.

In this study, trauma-related cases were classified as those who had sustained non-penetrating ocular trauma within 12 months prior to the occurrence of GRT-related RRD. Cases of high myopia were defined as those with an axial length longer than 26 mm or a refractive error greater than -6 diopters. The assessment of macular and vitreous status was conducted through a combination of pre-operative biomicroscopic examination and intraoperative findings. In cases where macular status was uncertain and appropriate imaging was available, optical coherence tomography was reviewed. The presence of PVR was graded according to an updated classification system28. The Snellen visual acuity (VA) was converted to the Logarithm of the Minimum Angle of Resolution (LogMAR) unit. The non-numerical Snellen vision categories of counting fingers, hand movement, light perception (LP), and no LP, the LogMAR values were determined to be 1.87, 2.30, 2.78, and 3.00, respectively29.

At the most recent follow-up, patients who achieved retinal reattachment but still had a silicone oil (SO) tamponade were classified as having an uncertain prognosis based on anatomical data. The remaining patients were divided into those who did not have the recurrent detachment and did not require additional surgical treatment after primary surgery during follow-up (classified as single surgery anatomical success, SSAS), those who achieved retinal reattachment but required subsequent surgery because of recurrent detachment, and those whose retina remained detached. Notably, additional surgery to remove SO or PFCL was not considered as constituting another operation. Patients were considered to have final surgical anatomical success (FSAS) if they had retinal reattachment, either after primary or reoperation, and no tamponade at the end of follow-up. Pinhole VA measurement was taken as a measure of final vision, and changes in a single Snellen VA line were used to classify the VA as better or worsening.

Statistical analysis

Continuous data were presented as mean and standard deviation (SD) or median and interquartile range (IQR) depending on their distribution. Categorical data were described as frequency and percent. Between-group comparisons were conducted using the t-test or Mann–Whitney test for continuous data, as appropriate, while the Fisher exact test was used for categorical data. A univariable and a backward stepwise multivariable logistic regression were used to explore factors associated with SSAS, while a univariable and a backward multivariable linear regression were used to investigate factors associated with final vision. The independent variables included gender, age, high myopia, trauma-related, lens and macular status, PVR grade, GRT location, the use of PFCL assisted, SB supplementation, and the use of SO tamponade in the primary operation. All statistical analyses were carried out using the STATA program, with a P-value < 0.05 considered statistically significant.

Results

Out of the 1,231 patients with RRD who underwent surgical repair between 2013 and 2021, 60 patients (4.9%) had GRT–RRD. These GRT patients had follow-up durations ranging from 3 to 54 months, with a mean (SD) of 21.2 (13.4) months. Thirteen (21.6%) patients experienced non-penetrating ocular trauma within a mean (SD) duration of 2.1 (2.2) months (range: 0.5–9 months) preceding the onset of RRD. The mean (SD) age of all GRT patients was 52.6 (11.0) years (range: 22–69 years), with 53 patients (88.3%) being male. Prior to presentation, patients reported visual alterations for a mean (SD) of 20.2 (26.3) days. Six patients (10%) had concurrent high myopia, none of whom were in the trauma-related group.

Regarding baseline ocular characteristics, the mean (SD) presenting LogMAR VA for all patients was 1.7 (0.9) units (Snellen equivalent: 20/1000). Twenty-two patients (36.7%) had a GRT extension of five clock hours, with none having a GRT circumference greater than six clock hours. Apart from GRT, 20 patients (33.3%) also exhibited adjacent small retinal breaks, while 54 patients (90%) had a macular-off status. Additionally, PVR of at least grade B was presented in 23 patients (38.3%). In the fellow eye, 1 patient (1.7%) sustained simultaneous RRD unrelated to GRT. All individuals exhibited a posterior vitreous detachment at presentation. The study discovered no relevant hereditary disorders that contributed to GRT. Table 1 provides a detailed description of the demographics and presenting characteristics of GRT patients by trauma-related categories.

Table 1 Demographics and presenting ocular features of patients with giant retinal tear and rhegmatogenous retinal detachment.
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Surgical interventions were mostly comparable between the non-trauma and trauma-related groups. For their primary operations, all patients underwent 23-gauge PPV. Out of 49 phakic patients, 6/36 patients (12.8%) and 5/13 patients (38.5%), P = 0.049, in the non-trauma and trauma-related groups underwent combined cataract surgery. Of note, 33/47 patients (70.2%) and 9/13 patients (69.2%) in the non-trauma and trauma-related groups used PFCL as an assisting agent during surgery (P = 1.000). In addition, 4/47 patients (8.5%) and 3/13 patients (23.1%), in the non-trauma and trauma-related groups also underwent SB in combination with PPV (PPV/SB), whereas 39/47 patients (82.9%) and 12/13 patients (92.3%) administered SO as an initial tamponade (P = 0.166 and P = 0.662, respectively). The mean (SD) operative time for PPV/SB was significantly longer than for PPV alone (127.8 (6.4) minutes versus 81.3 (21.9) minutes, P < 0.001). Intraoperatively, retinal slippage was observed in 1/13 patients (7.7%) and 4/47 patients (8.5%) in the non-trauma and trauma-related groups (P = 0.925). Table 2 provides a detailed description of the surgical procedures for primary GRT management by trauma-related categories.

Table 2 Intraoperative procedures during primary surgical interventions for patients with giant retinal tear and rhegmatogenous retinal detachment.
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Anatomical outcomes

Overall, after the primary surgical procedures, 44/60 patients (73.3%) achieved retinal reattachment. Among them, 36 patients (60%) achieved SSAS, while 8 patients (13.3%) achieved anatomical reattachment but remained tamponade by SO. The proportion of patients with SSAS did not differ significantly between the non-trauma (27/47, 57.5%) and the trauma-related group (9/13, 69.2%) (P = 0.534). Out of the 16 patients (26.7%) who did not achieve primary retinal reattachment, 7 underwent subsequent PPV with adjuvant SB (one with gas tamponade and six with SO tamponade), and 9 underwent subsequent PPV with additional membrane peeling (three with expansile gas tamponade and six with SO tamponade). The re-detachment related to the formation of PVR in 12 patients and new retinal breaks in 4 patients.

At the last follow-up, despite having a flattened retina, 17/60 patients (8 from primary surgery and 9 from subsequent reattachment surgery) remained with a tamponade by SO. The reasons for retaining SO were poor prognosis in 4 cases, patient denial in 7 cases, and appointment non-attendance in 6 cases. The remaining 43/60 patients (34 in the non-trauma group and 9 in the trauma-related group) were able to ascertain their final anatomical outcomes. Of the 34 patients who did not have trauma, 33 (97.1%) achieved final surgical anatomical success (FSAS), whereas 1 (2.9%) sustained retinal detachment. All 9 remaining patients (100%) in the trauma-related group attained FSAS. The proportion of patients who achieved FSAS was comparable between the two category groups (P = 0.661). Figure 1 illustrates the distribution of overall anatomical outcomes by trauma categories.

Fig. 1
figure 1

Distribution of final anatomical outcomes by trauma categories.

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Final visual outcomes

Among the 43 patients who determined their final anatomical outcomes, similar final vision was observed between the two trauma categories (median (IQR) LogMAR VA of 0.8 (0.4–1.0) units, Snellen equivalent of 20/125 for the non-trauma group and 1 (0.6–1.2) unit, Snellen equivalent of 20/200 for the trauma group, P = 0.331). Likewise, a similar proportion of patients with final vision worse than 20/400 was found in both groups (2/34 patients (5.9%) in the non-trauma group and 1/9 patient (11.1%) in the trauma-related group, P = 0.100). When considering the 17 patients who achieved retinal flattening but remained with a tamponade by SO, comparable final vision between trauma groups was also observed (median (IQR) LogMAR VA of 1.6 (1.0–1.9) units, Snellen equivalent of 20/800 for the non-trauma group and 1.4 (1.2–1.7) units, Snellen equivalent of 20/500 for the trauma group, P = 0.950). Regarding the percentage of patients with final vision worse than 20/400, there was no statistically significant difference between the non-trauma and trauma related groups (6/13 (46.2%) patients and 2/4 (50%) patients, P = 0.997, respectively). Nonetheless, compared to patients who did not retain SO, there was a tendency showing a larger number of patients with impaired vision. Figure 2 displays the distribution of final vision and Fig. 3 illustrates the distribution of final vision changes by trauma categories.

Fig. 2
figure 2

Distribution of final vision by trauma categories.

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Fig. 3
figure 3

Distribution of final vision changes by trauma categories.

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Postoperative complications

After the primary operation, retinal reattachment was not achieved in 16 out of 60 patients (26.7%). Patients who received perfluorocarbon liquid (PFCL) assistance during surgery did not exhibit any residual subretinal PFCL over the macular area. Those who used PFCL as a short-term tamponade did not experience temporary increases in intraocular pressure (IOP) or uveitis. During follow-up, cataract progression necessitating cataract surgery was observed in 24 out of 38 phakic patients (63.2%), 19 out of 30 patients in the non-trauma group, and 5 out of 8 in the trauma-related group (P = 1.00). Patients exhibiting high intraocular pressure requiring long-term topical antiglaucoma medications was significantly lower in the non-trauma group compared to the trauma-related group (7/47 patients (14.9%) and 6/13 patients (46.5%), P = 0.015, respectively). High intraocular pressure necessitating surgical intervention was found in 5/47 patients (10.6%) in the non-trauma group and 1/13 patients (7.7%) in the trauma-related group (P = 0.754), and 1 patient who was in the non-trauma group sustained persistent hypotony. Additionally, compared between the non-trauma and trauma-related groups, 10 patients (21.3%) vs 3 patients (23.1%), P = 0.867, developed mild epiretinal membrane (ERM) not requiring surgery, whereas 3/47 patients (6.4%) versus 1/13 patients (7.7%), P = 0.889, required subsequent PPV to remove significant ERM. None experienced corneal decompensation or endophthalmitis.

Table 3 presents univariable logistic regression for SSAS and univariable linear regression for final vision. For multivariable analysis using a backward stepwise approach that included the confounding factors listed in Table 3, no significant factors related to SSAS were found. However, there was a trend toward lowered SSAS rates in patients with PVR grade C (odds ratio 0.320, 95% CI 0.085–1.199, P = 0.091) and those with macular off status (odds ratio 0.224, 95% CI 0.036–1.382, P = 0.107). For the final visual outcome, a trend toward worse final VA was observed in patients with PVR grade C (odds ratio 0.327, 95% CI − 0.046 to 0.701, P = 0.084) and those of older age (odds ratio 0.232, 95% CI − 0.113 to 0.577, P = 0.183). However, none of the factors reached the threshold of statistical significance in the analysis.

Table 3 Univariable analysis of variables related with the probability of obtaining single surgery anatomical success and final vision following pars plana vitrectomy in patients with giant retinal tear associated rhegmatogenous retinal detachment.
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Discussion

In our retrospective case series, GRT/RRD accounted for approximately 5% of RRD cases treated at this tertiary center, with males making up the majority of patients. This finding aligns with previous studies that found GRT/RRD in the range of 0.5–8.3% of overall RRD cases, with male predominance1,3,30. The disparity in the proportion of GRT/RRD across studies may be partially attributed to differences in ocular characteristics and genetic predisposition among diverse ethnic groups. Nonetheless, our tertiary care setting, which receives complex referrals from multiple eye clinics, may overestimate the impact of GRT/RRD in the general population. A comprehensive nationwide study would provide a more realistic depiction of GRT–RRD distribution and its overall impact on the general population.

Notably, differences in proportion of traumatic cases and age group between studies were also observed. While up to 40% of GRT–RRD cases in previous studies were trauma-related, only about 20% of our patients had a recent history of non-penetrating ocular trauma4,5,7. Interestingly, the mean age for both non-traumatic and traumatic GRT–RRD patients in our study was 52 years, which is higher than the 33–53 year range reported in earlier studies30,31. This contrasts with a study by Aylward et al. which found that young men (mean age 29) were the at-risk group for GRT–RRD caused by either penetrating or non-penetrating ocular trauma32. These differences might be attributed to changes in age distribution and socioeconomic lifestyles over time. Our study also found a relatively low proportion of high myopia (10%) compared to other studies, which ranged from 6% in the United States to about 40% in Singapore, Egypt, and Chile4,6,30,33,34. Regarding GRT extent, patients in the traumatic-related group in this study showed a higher proportion of GRT that extending into the superonasal quadrant compared to the non-traumatic group, consistent with other studies1,32. These epidemiological characteristics provide valuable insight for assessing GRT–RRD in this location.

Surgical management of GRT-–RRD poses challenges26,35,36,37. Several studies have examined the factors influencing the success rate of primary retinal reattachment in patients undergoing PPV for GRT–RRD. Many confounding variables have been identified in these studies, including age, gender, extent of GRT, macular status, presence of PVR, the supplemental of SB, and the type of tamponade, though with some inconsistency6,31,38,39,40,41. Regarding the presence of pre-operative PVR and the choice of initial internal tamponade, Gonzales et al. examined GRT–RRD cases in which the non-penetrating ocular trauma accounted for 22% of the study group. The study discovered that patients with PVR at presentation and receiving long-acting gas as internal tamponade had a lower rate of obtaining SSAS compared to patients with SO tamponade. Furthermore, patients with a history of trauma were more likely to experience recurrent retinal detachment37. However, outcomes varied in other studies. Batman and Cekic conducted a randomized controlled trial on GRT–RRD patients with severe PVR (at least grade C or worse), one-fourth of whom experienced non-penetrating ocular trauma. They found comparable rates of complete posterior anatomical success and vision of 5/200 or better across patients treated with perfluoropropane (C3F8) gas, having SO removal, and having SO retention at month 4839. Similarly, a retrospective study by Moharram et al., including only nontraumatic patients with recent-onset GRT and low-grade PVR (grade B or less), observed similar final anatomical outcomes between SO and C3F8 tamponade groups. However, gas tamponade resulted in better final vision34. In addition, in research with a large number of complex GRT–RRD cases, Li et al. reported that a history of trauma (both non-penetrating and penetrating globe injury), presence of baseline PVR, and type of tamponade did not correlate with the probability of achieving SSAS6.

Our study found no association between SO tamponade and the presence of a baseline PVR to SSAS rate. In clinical practice, long-acting gas and SO may serve as useful tamponade options for managing GRT–RRD in both nontraumatic and traumatic populations. One geographic obstacle found in many tertiary referral centers, including our study, is the requirement for a two-step procedure when using SO tamponade. Employing gas tamponade may minimize these difficulties. This concern was also raised in a subgroup analysis of RRD patients with GRT by Adelman et al., which showed a comparable proportion of failure 1 (patients with final retinal attachment but requiring more than one surgery) when gas and SO were used as the tamponade agent, but a significantly higher proportion of failure 2 (patients with final retinal attachment but remaining tamponade by SO) in the SO-treated group27. However, when selecting a treatment approach for a patient, it is critical to weigh the overall risk of recurrent retinal detachment, such as age, the extent and location of the GRT, presence of PVR, a history of intraocular surgery, or even the patient’s ability for post-operative posturing.

Regarding the impact of SB, some researchers have theorized that adding SB to PPV could provide benefits by minimizing peripheral vitreoretinal traction, stabilizing the vitreous base, and supporting the anterior horn of the break. They have recommended using additional SB for patients with substantial PVR and the lower GRT location42. Other researchers, however, have claimed that the large size of the tear itself works as a natural relaxing retinotomy, potentially alleviating retinal traction without the need for additional SB43. Reports on the efficacy of combining SB with PPV for the management of GRT–RRD have been inconsistent. Certain studies have shown a lower success rate of retinal reattachment with PPV/SB, others have demonstrated a higher or comparable success rate compared to PPV alone44,45,46. Falavarjani et al. reported that the placement of supplemental SB and the presence of PVR were significant factors related to repeated PPV in multivariable analysis31. Alternatively, another multicenter retrospective analysis demonstrated that the advantage of incorporating SB to PPV was stratified by age. The authors showed that combined PPV/SB did not improve anatomical and visual outcomes at 6 months in adults at 6 months or 1 year when compared to PPV alone, but it did enhance these outcomes in children under the age of eighteen47.

In a systematic review covering studies up to August 2018, researchers identified only two conference abstracts of randomized controlled trials (RCTs) focused on GRT–RRD. No full-text publications were available for these studies. The abstracts suggested that eyes treated with PPV/SB had a higher rate of retinal attachment. However, the authors emphasized that the results were inconclusive due to the limited data available for proper assessment48. A meta-analysis, published recently, evaluated literature from 1950 to 2020, incorporating five retrospective studies that satisfied specific inclusion criteria: a sample size of at least 15 participants aged 3–83 years, treatment with either PPV or PPV/SB, and reporting of at least two outcome measures. This study found that PPV/SB was more effective than PPV alone in lowering recurrent RRD. However, the study conclusions were constrained by the reliance on non-randomized reports and the inherent risk of selection bias49. In our study, the combination of SB with PPV did not demonstrate significant improvements in SSAS or visual outcomes compared to PPV alone. However, the limited sample size, especially of young patients and those who received PPV/SB, precludes drawing definitive clinical conclusions from these results. Furthermore, in cases with recurrent retinal detachment with significant PVR, the use of supplement SB should be justified. The lack of standardized guidelines for GRT/RRD management, along with conflicting evidence on the effectiveness of PPV/SB versus PPV alone, emphasizes the importance of additional research to determine the proper surgical approach for primary and re-detached GRT–RRD. Due to the infrequent occurrence of GRT/RRD, a comprehensive study spanning multiple centers and ethnicities, utilizing randomized controlled trials, could be instrumental in settling the current controversies. Furthermore, establishing a uniform protocol for assessment and data gathering regarding GRT/RRD presentation and treatment in clinical settings would significantly mitigate bias in retrospective analyses conducted across various settings.

Perfluorocarbon liquid increases anatomical success in GRT/RRD situations by resolving multiple difficulties. It unfolds the inverted posterior retinal flaps, helps flatten the detached retina, improves the efficiency of endolaser treatment, and provides short to medium-term post-operative tamponade alternatives21,25,31. In our study, however, the use of PFCL during surgery varied according to individual surgeon preference, which may have introduced selection bias towards its usage in more complex primary cases. Additionally, the small number of participants in our study with GRTs extending beyond 180 degrees may have influenced our findings, indicating a lack of association between intraoperative PFCL use and final anatomical or visual outcomes. The trend in macular status and anatomical result may be indirectly related to the severity or chronicity of RD. However, given our study's limited statistical power, the interpretation should be considered with caution.

In terms of post-operative vision, both non-traumatic and traumatic-related groups, as well as patients with retained silicone oil, showed improvement, but there was no statistically significant difference between the groups. Even though our study found no significant factors impacting the final vision, the results convinced us that PPV is effective for managing GRT–RRD cases. However, comparing the proportion of visual change may be somewhat complicated by differences in terminology between publications. Additionally, there is published evidence of unexplained visual deterioration in eyes with long-term SO tamponade50. Nonetheless, the design of this study may not have adequately addressed this issue. Multimodal imaging techniques such as fundus autofluorescence, microperimetry, optical coherence tomography, or optical coherence tomography angiography may be used in future studies to corroborate the findings.

This study's limitations include its small sample size, which makes it difficult to appropriately control for various confounding variables while evaluating anatomical and visual characteristics. Similarly, the nonrandomized design and differences in treatment protocols could skew some findings. Additionally, due to financial and geographical barriers, several patients declined further care and returned to their local clinics, leading to incomplete final outcome evaluations. Nevertheless, in terms of GRT–RRD characteristics and outcomes described by both non-traumatic and traumatic-related groups, this study offers valuable insights into clinical practice.

Conclusion

Our study delineates differences in the epidemiological features of GRT–RRD between the non-trauma and trauma-related cases. While a smaller proportion of patients presented with high myopia, a higher incidence of GRT located in the superonasal quadrant was observed in the trauma-related cases. However, despite these distinctions, there was no significant difference noted in the proportion of patients achieving SSAS, FSAS, or vision improvement between the two groups These findings may indicate that, regardless of the cause, patients with GRT–RRD could achieve improvement in anatomical and functional outcomes with PPV. Further research with larger cohorts may provide additional insights into optimizing treatment strategies for GRT–RRD cases.