Characteristics and surgical outcomes of paediatric retinal detachment

Abstract

Purpose To report the clinical features and surgical and visual outcomes of rhegmatogenous retinal detachment (RRD) in the paediatric population. Methods A retrospective review of children (aged 0-15 years) who underwent primary surgical repair for RRD at the Hiroshima University Hospital between 1988 and 2001. Results In all 53 eyes of 49 patients were identified; paediatric RRD accounted for 3.1% of 1779 eyes with RRD operated on during this period. The causes of RRD included blunt trauma (27%), myopia (25%), idiopathic (20%), familial exudative vitreoretinopathy (13%), and others. Among 55 eyes, 12 (22%) already had proliferative vitreoretinopathy (PVR) of grade C or D preoperatively. The median initial visual acuity (VA) was 0.3. Retinal reattachment was achieved with a single operation in 78%. Final retinal reattachment was achieved in 87%. Retinal reattachment rates with and without PVR were 42% and 100%, respectively (Po0.01). Median final VA was 0.7. Final VA was X0.1 in 73% and X0.5 in 53%; four eyes had a final VA of no light perception. The presence of preoperative PVR (P ¼ 0.03) and the initial VA (Po0.0001) significantly affected final VA. Conclusions Paediatric RRD is characterised by a delay in diagnosis, as evidenced by the high rate of PVR at presentation. Retinal reattachment was adversely affected by the presence of PVR. Final VA correlated with the initial VA and was significantly affected by preoperative PVR. Early diagnosis may improve the visual prognosis of paediatric retinal detachment.

Evaluation and management of pediatric rhegmatogenous retinal detachment

“…3,4,9,55 In these series it is suggested to be the causative factor in 3-9% of cases. It is hypothesized that trauma from rubbing the eyes can lead to retinal detachments in these cases as retinal dialysis is common 55 and has been noted in up to 75% of these cases.…”

“…Congenital TORCH infections have also rarely been implicated as a causative factor. 2,9 A thorough medical history may point to an underlying etiologic factor in the cases of detachment related to a hereditary syndrome with systemic manifestations. Likewise, a family history, especially of retinal detachment or of need for ocular surgery at a young age, could point to a specific etiology.…”

“…1 Pediatric RRD is much less common, with an annual incidence only 0.38-0.69 per 100,000, 2 making up only 0.5-8% of all retinal detachments. [2][3][4][5][6][7][8][9] A number of case series of pediatric RRD have been reported (Table 1). [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Most of these case series include patients up to 18 years of age and the mean or median ages of presentation that are reported are 9-13 years of age.…”

Pediatric retinal detachment in the Eastern Province of Saudi Arabia: experience of a tertiary care hospital

“…This incidence is higher than reported in studies from other parts of the world. Yokoyama et al5 found an incidence of 3.1% of pediatric RRD (age 0-15 years; mean 12 years) of all RRD cases in the Japanese population, while Rumelt et al6 found an incidence of 6.6% (age 0-18 years; mean 10.8 years) in a mixed Middle Eastern population of mainly Caucasian descent. This higher incidence in our study may be related to factors such as a higher incidence of inherited myopia/vitreoretinal degeneration in children and ocular trauma in pediatric population due to socioeconomic factors in Saudi Arabia.…”

Pediatric Ophthalmology / Eye and Disorders

“…The second most common form is tractional, where the retina is pulled away from the underlying tissues. Exudative detachment develops when subretinal fluid accumulates under the retina such as in Coat's disease or vasoproliferative disorders (Yokoyama et al, 2004).…”