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Rhegmatogenous retinal detachments in children: risk factors and surgical outcomes
David V Weinberg1, Alice T Lyon, Mark J Greenwald
1Department of Ophthalmology, Northwestern University Medical School, Chicago, Illinois, USA.
Insights
Pediatric rhegmatogenous retinal detachments often have underlying structural abnormalities and trauma. While surgery reattaches the retina in most cases, visual recovery is limited, with poor preoperative vision being a key predictor.
Area of Science:
- Ophthalmology
- Retinal Surgery
Background:
- Rhegmatogenous retinal detachment (RRD) in children is less common than in adults.
- Identifying risk factors and surgical outcomes is crucial for pediatric RRD management.
Purpose of the Study:
- To describe the presenting features and surgical outcomes of pediatric rhegmatogenous retinal detachments.
- To identify risk factors associated with pediatric RRD and factors influencing visual outcomes.
Main Methods:
- Retrospective, noncomparative, interventional case series.
- Chart review of 34 children (39 eyes) aged 18 or younger with RRD.
- Classification of risk factors into structural abnormalities, trauma, previous surgery, and uveitis.
Main Results:
- Congenital/developmental structural abnormalities were the most common risk factor (56%).
- Retinal reattachment was achieved in 79% of eyes, but visual recovery was modest (median visual acuity 20/400 postoperatively).
- Poor preoperative vision, macula-off detachment, vitrectomy, proliferative vitreoretinopathy, and silicone oil use predicted poor visual outcomes.
Conclusions:
- Congenital/developmental factors are significant in pediatric RRD.
- Modern vitreoretinal surgery is effective for retinal reattachment.
- Visual outcomes are influenced by multiple factors, similar to adults, with poor preoperative visual acuity being a novel predictor.
Purpose:
To describe the presenting features and surgical outcomes in a series of children with rhegmatogenous retinal detachments.
Design:
Retrospective, noncomparative, interventional case series.
Participants:
Thirty-nine eyes of 34 children 18 years of age or younger undergoing surgery for rhegmatogenous retinal detachment.
Methods:
Patients were identified by chart review at two affiliated tertiary care centers. Risk factors for retinal detachment were classified into four categories: (1). congenital or developmental structural ocular abnormalities, (2). trauma, (3). previous ophthalmologic surgery, and (4). preceding uveitis.
Results:
Median age was 10 years, and 79% of patients were boys. Nine patients (26%) had bilateral retinal detachment at presentation, or experienced a detachment in their second eye before their nineteenth birthday. Every eye had at least one risk factor for retinal detachment, and more than half had risk factors in two or more categories. Structural abnormalities were most common (56%). Fifty-one percent of eyes underwent previous surgery, 36% experienced trauma, and 15% had uveitis. Detachments tended to be complex. Median follow-up was 24 months. Retinal reattachment was achieved in 79% of eyes; however, visual recovery was modest. Median preoperative and postoperative visual acuities were counting fingers and 20/400, respectively. Predictors of a poor visual outcome were: unmeasurable or light perception-only preoperative vision (P = 0.0001), macula-off retinal detachment (P = 0.01), the need for vitrectomy surgery (P = 0.01), the presence of proliferative vitreoretinopathy grade C or worse (P = 0.02), and the use of silicone oil (P = 0.02).
Conclusions:
Predisposing factors in pediatric retinal detachments, particularly congenital and developmental structural abnormalities, may be more common than previously reported. Modern vitreoretinal surgical techniques can help achieve retinal reattachment in most cases. Many factors contribute to the limited visual recovery in this patient population. Predictors of visual outcomes are similar to those observed in adults. Inability of the clinician to determine confidently the preoperative visual acuity is a newly identified predictor of poor visual outcomes.
