[Vitreoretinal surgery in complicated retinal detachment in children and adolescents]

The purpose of this study was to evaluate anatomical and functional results of vitreoretinal silicone oil surgery for complicated retinal detachments due to trauma and myopia in children and juveniles.

We retrospectively reviewed the records of children and juveniles up to 17 years of age who had undergone vitreoretinal surgery with silicone oil instillation for the above causes between 1990 and 1997. A total of 30 eyes of 29 patients were operated on, 24 because of trauma and the remaining 6 because of retinal detachment in high myopia. There was a mean postoperative follow-up period of 1.7 years. Silicone oil could be removed from 18 of the 30 eyes after a mean of 4.7 months. The median number of vitrectomies performed per eye was two (range one to five).

In 21 of 30 eyes (70%) the retina could be reattached after one or more surgeries. Silicone oil was removed from 16 of these 21 eyes (53%) which was defined as anatomical success. Visual acuity increased (14 eyes, 48.3%) or remained unchanged (9 eyes, 31%) in 23 of 29 eyes (79.3%). Visual acuity decreased in 6 of 29 eyes (20.7%) despite surgery. Two eyes (6.7%) had to be enucleated due to bulbar phthisis. Seventeen eyes reached a postoperative visual acuity of at least counting fingers. In one child functional tests could not be performed due to young age.

Vitreoretinal surgery with silicone oil endotamponade has become a standard procedure in treating complicated retinal pathologies in children and juveniles. In very young patients it is thought that silicone oil instillation has advantages over gas endotamponade since it is very difficult for children to keep the proper face-down positioning after the procedure. The retinal reattachment rate is encouraging. In the majority of cases visual acuity greater than or equal to counting fingers and thus orienting vision was reached postoperatively. In few cases even reading vision was regained.