[Trauma-associated juvenile rhegmatogenous retinal detachment]

Area of Science:

• Ophthalmology
• Retinal Surgery
• Pediatric Eye Care

Background:

• Rhegmatogenous retinal detachments (RRD) are rare in children and adolescents, comprising 3-5% of all cases.
• Pediatric RRD etiology, pathogenesis, and treatment differ significantly from adult cases.
• This study focuses on juvenile RRD following trauma to address knowledge gaps.

Purpose of the Study:

• To analyze the characteristics, surgical management, and outcomes of traumatic Rhegmatogenous Retinal Detachments (RRD) in pediatric patients.
• To identify common retinal breaks and challenges in treating juvenile RRD.
• To evaluate the effectiveness of different surgical approaches in achieving retinal reattachment and visual acuity preservation.

Main Methods:

• Retrospective analysis of 27 eyes from 25 patients (up to 18 years old) operated on between 2000 and 2012.
• Inclusion criteria: patients with traumatic RRD, representing 42.4% of RRD in this age group.
• Data collected included demographics, detachment characteristics, surgical techniques (episcleral buckling, vitrectomy), and outcomes.

Main Results:

• The mean patient age was 15.3 years, with 77% being male. Trauma-to-detachment intervals ranged from days to 11 years (median 3.5 months).
• Macular detachment occurred in 81.5% of cases. Retinal dialysis (44.8%) and giant retinal tears (18.5%) were the most frequent breaks.
• Primary reattachment rates were 83% for buckling and 80% for vitrectomy. All eyes achieved retinal attachment post-surgery, with improved or stable visual acuity in successfully treated cases. Cataract formation was noted in 50% of phakic eyes post-vitrectomy.

Conclusions:

• Retinal dialysis and giant retinal tears are primary lesions in post-traumatic RRD in children.
• Delayed diagnosis is common, often presenting as macula-off and chronic RRD, impacting final visual outcomes.
• Scleral buckling is recommended for manageable cases, while vitrectomy with silicone oil is necessary for complex detachments. Despite challenges, successful surgery preserves vision, crucial for long-term quality of life.