To the Editor.
—We were surprised and perplexed by the article by Brown and Benson1 describing their technique for closing giant retinal tears (GRTs) of 180° or more with rolled posterior flaps.The authors used sodium hyaluronate as an agent to unfold the posterior flap after all conventional methods, including silicone oil-fluid exchange, had failed to unfold the retina "before the eye... [could]... be fully filled with gas or silicone oil." We believe this method is incorrect and not a logical approach to the problem, for the following reasons:
Persistent retinal folding in GRTs may be the result of epiretinal membrane proliferation and shortening or (occasionally) of incomplete removal of vitreous gel from the free surface of the flap.
Persistent retinal folding in GRTs is readily managed by completing the silicone oil exchange. Once preretinal and subretinal fluid is removed, the free edge of the folded GRT
Lavin MJ, Leaver PK. Sodium Hyaluronate and Giant Retinal Tears. Arch Ophthalmol. 1990;108(4):480. doi:10.1001/archopht.1990.01070060026010