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Published on: August 14, 2013
Pediatric Rhegmatogenous Retinal Detachments: Etiologies, Clinical Course, and Surgical Outcomes
Madeline E Sparks1,2, Pedro J Davila1,2, Yu-Guang He1,2
1University of Texas Southwestern Medical Center, Dallas, TX, USA.
Insights
Pediatric rhegmatogenous retinal detachment (RRD) is often linked to trauma, myopia, or prior surgery. Scleral buckle surgery showed higher success rates for RRD repair in children compared to vitrectomy alone.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Retinal Diseases
Background:
- Pediatric rhegmatogenous retinal detachment (RRD) is a rare but serious condition.
- Predisposing factors significantly influence the presentation and outcomes of pediatric RRD.
Purpose of the Study:
- To identify predisposing factors for pediatric RRD.
- To describe the clinical course and surgical management of pediatric RRD.
- To determine factors influencing anatomic success after surgical repair.
Main Methods:
- Retrospective analysis of 101 eyes from 94 patients (≤18 years) undergoing RRD surgical repair.
- Data collected from January 1, 2004, to June 31, 2020, with ≥6 months follow-up.
Main Results:
- 90% of pediatric RRD cases had predisposing factors: trauma (46%), myopia (41%), prior intraocular surgery (26%), congenital anomaly (23%).
- Macula-off RRD (81%) and high-grade proliferative vitreoretinopathy (PVR) (34%) were common at presentation.
- Scleral buckle (SB) alone achieved higher anatomic success rates than vitrectomy alone or combined procedures (P=.0002).
- PVR grade C or worse, total RRD, and vitrectomy alone were associated with poorer outcomes.
Conclusions:
- Pediatric RRD is frequently associated with identifiable risk factors.
- Patients often present with advanced disease, including macula-off detachments and significant PVR.
- Scleral buckle surgery demonstrates superior anatomic success rates in pediatric RRD repair.
Abstract:
Purpose: To describe the predisposing factors, clinical course, and surgical methods of pediatric rhegmatogenous retinal detachment (RRD) and determine which factors affect anatomic success. Methods: Data of patients 18 years or younger who had surgical repair for RRD from January 1, 2004, to June 31, 2020, with a minimum of 6 months of follow-up were retrospectively analyzed. Results: The study evaluated 101 eyes of 94 patients. Of the eyes, 90% had at least 1 predisposing factor to pediatric RRD, including trauma (46%), myopia (41%), prior intraocular surgery (26%), and congenital anomaly (23%); 81% had macula-off detachments and 34% had proliferative vitreoretinopathy (PVR) grade C or worse at presentation. The presence of PVR grade C or worse (P = .0002), total RRD (P = .014), and vitrectomy alone at first surgery (P = .0093) were associated with worse outcomes. Patients who had scleral buckle (SB) alone at the first surgery had statistically higher rates of anatomic success than those who had vitrectomy alone or combined with SB (P = .0002). After the final surgery, 74% of patients achieved anatomic success. Discussion: The majority of cases in this study were associated with 1 of the 4 risk factors predisposing to pediatric RRD. These patients often present late with macula-off detachments and PVR grade C or worse. The majority of patients achieved anatomic success after surgical repair using SB, vitrectomy, or a combination.
