Aberrant angiogenesis, inflammation, and fibrosis in pediatric vitreoretinal surgical diseases

Pediatric rhegmatogenous retinal detachment (RRD) is usually caused by trauma or myopia, but can also be a comorbidity of genetic or congenital diseases or a complication after previous eye surgery. Pediatric RRD is challenging due to late diagnosis, distinct ocular anatomy compared to adults, and a higher prevalence of proliferative vitreoretinopathy (PVR). Late diagnosis due to limited symptom awareness, especially in younger children, ultimately leads to poor surgical outcomes, causing chronic detachment and PVR formation. Pediatric patients are susceptible to more severe PVR due to stronger proliferative and inflammatory responses compared to adults e.g. after trauma or retinal break. To achieve structurally and functionally positive outcomes after surgical intervention, RRD in children must be diagnosed and treated promptly. Surgical treatment options for pediatric RRD include scleral buckling, vitrectomy, laser treatment, and cryotherapy. The success rate of pediatric RRD eye surgery is lower, and the incidence of preoperative or postoperative PVR is higher, compared to adults. PVR causes retinal redetachment and is characterized by contractile proliferative membranes especially at the vitreoretinal interface, but also intraretinally/subretinally. Inflammatory and proliferative responses are more pronounced in pediatric eyes compared to adults. Only a few studies specifically focusing on pediatric cases have been conducted to prevent fibrotic scarring changes in PVR. We present pediatric (aged ≤18 years) fibrotic vitreoretinal diseases and related research from the interface of laboratory and clinical perspectives. Further studies are needed to elucidate the vitreous and retinal diseases in pediatric patients that are associated with inflammatory, proliferative, and fibrotic changes leading to PVR, both preoperatively and postoperatively. More information is needed on how to prevent these conditions and how to improve the anatomical and functional visual acuity of the eye in pediatric retinal diseases.