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Rhegmatogenous retinal detachment in paediatric patients after pars plana vitrectomy and sutured scleral-fixated
P Sen1, S I Shaikh1, K Sreelakshmi1
1Shri Bhagawan Mahavir Vitreo-Retinal Services, Sankara Nethralaya, Chennai, India.
Insights
Rhegmatogenous retinal detachment (RRD) occurred in 5.7% of pediatric eyes after pars plana vitrectomy with sutured scleral-fixated intraocular lens (SSFIOL) implantation. Outcomes were better without proliferative vitreoretinopathy (PVR).
Area of Science:
- Ophthalmology
- Retinal Surgery
- Pediatric Ophthalmology
Background:
- Pars plana vitrectomy with sutured scleral-fixated intraocular lens (SSFIOL) implantation is a common procedure in pediatric eyes.
- Rhegmatogenous retinal detachment (RRD) is a potential complication following intraocular surgery.
- Understanding the incidence and outcomes of RRD after SSFIOL in children is crucial for patient management.
Purpose of the Study:
- To determine the incidence rate of RRD in pediatric eyes undergoing SSFIOL implantation.
- To analyze the management strategies and surgical outcomes for RRD in this patient population.
- To identify factors associated with visual prognosis after RRD in children.
Main Methods:
- Retrospective analysis of 16 eyes from 15 children who developed RRD after PPV with SSFIOL.
- Evaluation of surgical details, structural, and functional outcomes.
- Statistical analysis to identify factors influencing visual outcomes, including best-corrected visual acuity (BCVA) and proliferative vitreoretinopathy (PVR).
Main Results:
- RRD occurred in 5.7% of 279 pediatric eyes that underwent PPV with SSFIOL.
- The average age of affected children was 10.7 years.
- Retinal reattachment was achieved in 87.5% of eyes, with a median of one surgery.
- Poor visual outcomes were associated with BCVA at RRD onset, multiple surgeries, and pre-existing PVR.
Conclusions:
- SSFIOL surgery in pediatric eyes carries a 5.7% risk of vision-threatening RRD.
- Surgical outcomes for RRD are significantly better in the absence of PVR (100% attachment) compared to its presence (75% attachment).
- Emphasizing regular follow-up and parental self-monitoring of vision is essential before SSFIOL surgery in children.
Abstract:
PurposeTo report the incidence rate, management, and surgical outcomes of rhegmatogenous retinal detachment (RRD) in children who underwent pars plana vitrectomy (PPV) with sutured scleral-fixated intraocular lens implantation (SSFIOL).Patients and methodsOf the 279 eyes of 230 children who underwent PPV with SSFIOL at a tertiary eye care centre, 16 eyes of 15 children developed RRD. Retrospective analysis of the surgical details of RRD, the structural and functional outcomes was done.ResultsOf the 279 eyes of 230 children who underwent PPV with SSFIOL, RRD was seen in 5.7% of the eyes. Average age was 10.7 years (range 4-15 years). Indication for SSFIOL implantation was congenital subluxation of lens (8 eyes) and traumatic aphakia or lens subluxation (4 eyes each). PPV was done in 15 of the 16 eyes, and 1 patient underwent scleral buckling. Retina was attached at the last follow-up visit in 87.5% of the eyes with median number of surgeries being 1. BCVA at the time of retinal detachment, multiple surgeries, and PVR at presentation were associated with poor visual outcome.ConclusionSurgery for SSFIOL in our series of paediatric eyes was complicated by vision-threatening RRD in 5.7% of cases. Surgical outcome in eyes with RRD without PVR was better (100%) than that in those, where PVR had already set in (75%). Need for regular follow-up and self-monitoring of vision should be emphasized and discussed with the parents before surgical intervention.
