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Pediatric rhegmatogenous retinal detachment
1Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia, USA. gfivgas1@home.com
Insights
Pediatric rhegmatogenous retinal detachment (RRD) often stems from myopia or prior surgery. While most cases achieve reattachment, preserving vision in children with RRD is crucial due to associated ocular pathologies.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Pediatric Eye Care
Background:
- Pediatric rhegmatogenous retinal detachment (RRD) is a rare but serious condition.
- Associated ocular pathologies are common in children with RRD.
- Myopia and previous intraocular surgery are leading causes of pediatric RRD.
Purpose of the Study:
- To analyze the clinical features of pediatric RRD.
- To evaluate surgical and visual outcomes in pediatric RRD patients.
- To understand the long-term visual prognosis for children with RRD.
Main Methods:
- Retrospective case series over 6 years (1991-1997).
- Included pediatric patients (0-18 years) with RRD.
- Excluded trauma and acute retinopathy of prematurity.
Main Results:
- 29 eyes in 27 pediatric patients reviewed.
- Myopia and prior intraocular surgery were the most common etiologies.
- 72% of eyes achieved anatomic reattachment after an average of 2.2 surgeries.
- 41% of eyes had visual acuity of 20/800 or better at final follow-up.
Conclusions:
- Pediatric RRD is frequently linked to myopia and prior intraocular surgery.
- Successful anatomic reattachment is achievable but often requires multiple interventions.
- Vision preservation is critical, considering the high incidence of vision-threatening issues in fellow eyes.
Purpose:
To review the clinical features and surgical and visual outcomes of pediatric rhegmatogenous retinal detachment (RRD) as seen in a tertiary referral center.
Methods:
Retrospective case series spanning 6 years from January 1, 1991 to January 1, 1997. Exclusionary criteria were trauma disrupting the globe and acute retinopathy of prematurity.
Results:
The authors reviewed a series of 29 eyes in 27 pediatric patients (birth to 18 years of age) with RRD. Seventy percent of the patients were male. The mean patient age was 9.6 years. Bilateral RRD was present in 22% of patients; 89% of patients had some form of bilateral ocular pathology at initial presentation. The two most common etiologies (34% each) were myopia and eyes that had undergone surgery for another ocular disorder with subsequent development of RRD. The most common presentation was decreased vision, with a mean duration of 52 days. At presentation, 75% of the affected eyes and 48% of the fellow eyes had visual acuity worse than 20/800. The most common type of retinal break was a horseshoe tear. Late diagnosis was a common problem, evidenced by the frequency of macular detachment (79%) and proliferative vitreoretinopathy (45%) at initial presentation. The most common primary repair was a scleral buckle. Anatomic reattachment was ultimately accomplished in 72% of cases with a mean of 2.2 surgeries per eye. Average postoperative follow-up time was 21.4 months (range 4 to 61 months). At final follow-up, 41% of the affected eyes had visual acuity 20/800 or better. Thirty-eight percent of the affected eyes had a final visual acuity better than or equal to the fellow eye.
Conclusion:
In this series, pediatric RRD occurred most commonly in association with myopia (Stickler's syndrome and adolescent retinopathy of prematurity) and prior intraocular surgery. Most eyes were anatomically reattached after multiple surgeries. Forty-one percent of eyes retained vision of 20/800 or better. Preserving vision in children with RRD is of great importance, particularly given the 89% frequency of vision-threatening abnormalities in fellow eyes.