Chorioretinal coloboma in a paediatric population

Abstract

Aim To determine the validity of laser photocoagulation as a prophylactic treatment in the prevention of rhegmatogenous retinal detachment (RRD) in a group of paediatric patients presenting with chorioretinal coloboma. Methods Observational case series of consecutive patients aged 0-15 years with chorioretinal coloboma seen in a tertiary eye hospital were reviewed. Data were analysed with SPSS version 16, a P-value of o0.05 was considered significant. Results One hundred and ninety-eight patients (335 eyes) were identified. The prevalence of retinal detachment and ocular anomalies was 17.6 and 87.2%, respectively. Ocular anomalies included iris coloboma (71%), microcornea (45.1%), nystagmus (41.5%), strabismus (21.2%), and microphthalmos (19.1%). The prevalence of retinal detachment was 2.9% in those eyes that received prophylactic laser photocoagulation, whereas the risk of retinal detachment was 24.1% in eyes left untreated. Post-operative complications following retinal detachment surgery occurred in 86.7% eyes; the most frequent being recurrent retinal detachment (53.8%). The mean duration of follow-up was 1.59 ± 0.21 years (0-7 years) and 0.79 ± 0.16 years (0-8 years) in the group that had laser and in those that were treatment naive, respectively. Conclusions Prophylactic laser treatment appears to have a protective effect for the prevention of RRD in eyes with chorioretinal coloboma. Measures towards prophylactic therapy should be instituted to reduce the risk of retinal detachment in choroid colobomatous eyes due to the problems in the management of these retinal detachments.

Prophylactic laser photocoagulation of fundal coloboma: does it really help?

“…The cases of FC, which underwent PLP, maintained visual acuity during follow-up, which ranged from a minimum of 3 years to a maximum of 17 years (median 5 years). A similar benefit of PLP has been reported in a study in which RRD developed in 2.9% eyes which underwent PLP in contrast to 24.1% eyes that did not (Uhumwangho & Jalali 2014). Lack of a control group and selection bias due to the hospital setting are the major limitations of our study.…”

“…The authors report the clinical experience from their practice at a tertiary care hospital that apparently showed a drastic benefit of PLP in reducing the incidence of RRD when compared to the literature (Patnaik & Kalsi 1981;Gopal et al 1998;Uhumwangho & Jalali 2014). The cases of FC, which underwent PLP, maintained visual acuity during follow-up, which ranged from a minimum of 3 years to a maximum of 17 years (median 5 years).…”

“…We have also successfully used chlorhexidine gluconate 0.1% for cataract surgery antisepsis. Gopal et al 1998;Uhumwangho & Jalali 2014). In most of the cases of RRD in FC, the break lies inside the coloboma, or at 'locus minoris resistentiae' (Gopal et al 1998).…”

Chorioretinal coloboma: clinical presentation complications and treatment alternatives

“…1,5−7 CRC can be sporadic or genetically transmitted as an autosomal recessive, autosomal dominant or X-linked trait. 2,5,8 Uhumwangho and Jalali 2 reported parental consanguinity in 28.8% of the 198 patients in their series. Even it can present more frequently in some families as presended by several reports a specific mutation or genetic pathway was not found yet.…”

“…Several classifications for CRCs have been reported based on anatomic localization and severity. 2,9 Uhumwangho and Jalali 2 reported 7 types of colobomas according to Ida Mann classification. Type 1-coloboma extending above the anatomic disc, Type 2-coloboma extending up to superior border of disc, Type 3-coloboma extending below the lower border of disc, Type 4-coloboma involving the disc only, Type 5-coloboma present below the disc with normal retina above and below the coloboma, Type 6-pigmentation present in the periphery, Type 7-coloboma involving only the periphery (Figure 1).…”