Just as vitreous pulling creates small retinal tears, it can also cause very large retinal tears. If the retinal tear is very great (one quarter of the retina or more), it is called a "giant retinal tear." Occasionally, the tear is so large that the retina folds over on itself, like a piece of paper folded in half. A giant retinal tear is a very serious problem.
Vitreous surgery, scleral buckling, and laser treatment may be used to treat giant retinal tears. The lens of the eye must be removed to make this surgery successful. The goal of the surgery is to unfold the retina, put it back in place, and seal it into its proper position. Sometimes the patient must be turned face down during surgery. The surgeon may then inject an air bubble into the eye to push the retina against the wall of the eye. The patient may then be turned onto his back so that laser treatment can be done to seal the retina in place. Silicone oil or other thick material may also be used to unfold and reattach a giant retinal tear.
Although some patients see well after surgery for giant retinal tears, most do not. Most will recover enough vision to get around. Despite modern techniques to reposition the folded retina and hold it into place, many eyes develop scar tissue (proliferative vitreoretinopathy) after the surgery and the retina again becomes detached.