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Pediatric rhegmatogenous retinal detachment: predictors of anatomic and functional success
Mario Carranza-Casas1, Erick Quiroz-González2, Alejandro Hernández-Reyes2
1Instituto de Oftalmología Conde de Valenciana IAP, Mexico City, Mexico. mcc.9105@gmail.com.
Insights
Successful repair of pediatric rhegmatogenous retinal detachment (RRD) is achievable, with factors like age and macula involvement influencing outcomes. Scleral buckling techniques showed higher success rates than pars plana vitrectomy alone.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Pediatric Eye Care
Background:
- Pediatric rhegmatogenous retinal detachment (RRD) is a rare but sight-threatening condition.
- Understanding factors influencing successful surgical repair in children is crucial for optimizing outcomes.
- Previous studies have focused on adult RRD, necessitating specific analysis for pediatric populations.
Purpose of the Study:
- To describe clinical features and surgical techniques for successful pediatric RRD repair.
- To identify factors associated with favorable anatomical and visual outcomes in young patients.
- To compare the efficacy of different surgical approaches in pediatric RRD.
Main Methods:
- Retrospective case series of 242 pediatric patients (<18 years) with new-onset RRD.
- Analysis of 168 surgically treated cases with a minimum 3-month follow-up.
- Statistical analysis (Chi-squared, logistic regression, GEE) to compare features and outcomes.
Main Results:
- Overall anatomical success (total reattachment) was 62%, and visual success was 54%.
- Factors associated with success included absence of macular involvement, subtotal RRD, and older age (13-18 years).
- Scleral buckling (SB) and combined SB/pars plana vitrectomy (PPV) yielded higher success rates than PPV alone.
Conclusions:
- The majority of pediatric RRD cases achieve anatomical success with surgical repair.
- Myopia and trauma are common causes; myopic patients tend to have better outcomes.
- Subtotal RRD and uninvolved macula predict success, while previous intraocular surgery and younger age are risk factors for failure.
Purpose:
This study describes presenting clinical features and surgical techniques associated with successful repair of pediatric rhegmatogenous retinal detachment (RRD).
Methods:
This is a retrospective case series which involved 242 cases younger than 18 years with new-onset RRD with descriptive statistics for the full group. Further exclusion established 168 cases that underwent surgery with minimum 3-month follow-up. Comparison of features associated with successful outcomes was analyzed using Chi-squared tests, logistic regression and univariate generalized equation models.
Results:
We measured proportion of patients with BCVA ≤ 1.0 logMAR and/or an increase in final BCVA of 0.3 logMAR with respect to baseline and complete reattachment at final visit; 104 eyes (62%) achieved total reattachment, and 91 eyes (54%) achieved visual success. Absence of macular involvement, subtotal RRD and older age group (13-18) were associated with both success measures. There were higher visual and anatomic success rates with primary scleral buckling (SB, 66% and 79%; OR 9.26 and 11.09) and combined SB plus pars plana vitrectomy (PPV, 54% and 58%; OR 5.67 and 3.94) compared with PPV alone (26% and 17%).
Conclusion:
A majority of patients achieved anatomical success with repair. Trauma and myopia were the most common etiologic associations, with myopic cases having better outcomes. Success was more likely in patients with subtotal RRD or uninvolved macula at presentation; previous intraocular surgery was a risk factor for failure. Younger patients had a higher likelihood of worse outcomes. Initial PPV showed a lower rate of success than either SB or combined SB/PPV.
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