Clinical characteristics and surgical outcomes of pediatric rhegmatogenous retinal detachment

The objective of this study was to analyze the characteristics and surgical results of pediatric rhegmatogenous retinal detachment (RRD). The medical records of 30 eyes of 29 patients younger than 18 years of age who underwent vitreoretinal surgery due to RRD were analyzed. The gender, age, laterality, duration of presenting symptom, etiology, ocular and systemic co-morbidities, type of breaks, lens status, presence of proliferative vitreoretinopathy (PVR) and its grade, initial and final best-corrected visual acuities (BCVAs), surgical management, number of operations, duration of follow-up, functional and anatomical success, and complications were noted. As the most common predisposing factors were trauma (trauma group) and myopia (myopia group), the data of these patients were further analyzed. The mean age was 12.6 ± 3.0 years. There were 23 male (79.3 %) and 6 female (20.6 %) subjects. The most common etiologic factors were high myopia (40 %) and trauma (36.6 %). Functional success rate was 70 % (n = 21) after the primary surgeries and was 80 % (n = 24) after the secondary surgeries. There were no significant differences between the trauma and myopia groups regarding the presence of total retinal detachment, macula-off status, and the rate of PVR worse than grade C. Although the preoperative mean BCVA and the initial and final retinal reattachment rates of the groups were statistically similar, trauma group had significantly higher postoperative mean BCVA compared to myopia group (p = 0.013). Myopia and trauma were the most common etiologic factors for RRD in children. The visual outcomes of trauma-associated RRD were better than those of myopia-associated RRD.     

Pediatric rhegmatogenous retinal detachment: clinical features and surgical outcomes

OBJECTIVE: To describe the characteristics of and surgical outcomes for primary pediatric rhegmatogenous retinal detachment (RRD) and to evaluate whether specific characteristics impact anatomical outcomes after surgical intervention. METHODS: Data for consecutive patients (18 years of age or younger) with RRD who required surgery over a 5-year period were studied retrospectively. Patients with recurrent retinal detachment or active retinopathy of prematurity were excluded. RESULTS: Forty-six eyes of 45 patients (median age, 9 years) were included. Ninety-eight percent of the patients had at least 1 predisposing factor, including prior surgery (61%), trauma (43%), developmental abnormality (35%), and myopia (17%). Retinal reattachment was attained in 78% of eyes. Younger age (P = 0.019), worse initial vision (P = 0.008), greater extent of retinal detachment (P = 0.007), and presence of proliferative vitreoretinopathy (grade C or worse) (P = 0.008) were associated with worse anatomical outcomes. Vision improved after surgery in 56% of patients, but overall visual results were modest. Thirty-seven percent of patients had vision-threatening lesions in the other eye, and 18% had a history of retinal detachment in the fellow eye. CONCLUSIONS: Pediatric RRD is often associated with a predisposing factor. Favorable anatomical and visual outcomes are possible, and lesions in the fellow eye are common.     

学龄期儿童独眼视网膜脱离临床特点和手术效果分析

目的：探讨学龄期儿童独眼视网膜脱离(RD)潜在病因以及RD临床特点。

方法：回顾性分析2015-11/2021-05于本院就诊的7～14岁儿童患者如下病例：患眼RD且对侧眼盲目(独眼RD)。描述并探讨其一般情况及RD病因、临床类型、手术方式、眼内填充物类型、手术前后视功能和解剖预后等。

结果：共纳入27例27眼独眼RD患者,随访至少6mo以上。平均就诊年龄为10.63±2.30岁。家族性渗出性玻璃体视网膜病变(FEVR)(11/27,41%),先天性青光眼术后(6/27,22%)和Stickler综合征(3/27,11%)为主要致病原因。其中,孔源性视网膜脱离(RRD)占78%(21/27),孔源性视网膜脱离患者(17/21)中81%的患者表现为增殖性玻璃体视网膜病变(PVR)C3及以上。共有85%(23/27)的患者行玻璃体切除术,其中83%(19/23)的患者手术中联合硅油填充。末次随访最佳矫正视力(BCVA,LogMAR)低于1.7的患者占78%(21/27),82%(22/27)的患者末次随访时视网膜平复在位,而41%(11/27)的患者末次随访时硅油尚未取出。

结论：学龄期儿童独眼RD常合并潜在的先天或遗传性眼病,且常表现为严重的RD和较重的PVR反应,多需玻璃体切除术联合硅油注入,视功能和解剖预后也较差。     

Etiologies and surgical outcomes of pediatric retinal detachment in Hong Kong

The purpose of this study was to study the etiologies and operative outcomes of pediatric retinal detachment at a tertiary eye referral center in Hong Kong over a 10-year period. A retrospective study of patients (below 18 years of age) who received primary retinal detachment repair operations at a University Teaching Hospital between 2005 and 2015 was conducted. The study comprised 37 patients with 39 eyes affected who received primary retinal detachment (RD) surgery. Two patients had bilateral RD. 69.2 % were male. The mean follow-up period was 40.6 ± 28.6 months. Their mean age at presentation was 13.4 ± 5.5 years. There were contributing factors for RD identified in 33 eyes (84.6 %), of which congenital/developmental anomalies (23.1 %), high myopia with refractive error greater than ?6 diopters (17.9 %), and trauma (15.4 %) ranked the top 3 causes for RD. The retina was reattached after one surgical procedure in 69.2 %. Final anatomical success rate was 82.1 %. Postoperatively, 68.8 % of eyes had improved or stable vision. Functional visual loss with visual acuity less than 5/200 was found to be 30.6 % of eyes which were mostly from younger patients and those with congenital anomalies. Pediatric retinal detachment is often associated with predisposing factors. The presence of congenital/developmental ocular anomalies causing retinal detachment is more frequent in younger children and with worse functional and visual outcomes. Continuing efforts to improve treatment strategies for this group of patients are needed.     

Visual and surgical outcomes of retinal detachment following macular hole repair

OBJECTIVE: To characterize 20 cases of retinal detachment (RD) following surgical repair of macular holes. METHODS: Retrospective review of 20 eyes in 16 patients (4 patients [25%] had bilateral macular hole repairs with subsequent RD) who developed RD in the same eye in which surgical repair of a macular hole had been performed. RESULTS: Twenty detachments in 16 patients were reviewed. The average duration between macular hole repair and presentation of RD was 5.5 weeks. The inferior retina was involved more frequently than the superior retina. A total of 76% of all breaks were located inferiorly. Ten of the 20 eyes were asymptomatic at the time the detachment was diagnosed. Of the 20 eyes, 19 underwent surgical repair, all with anatomic reattachment. At final follow-up, the macular hole was closed in all 20 eyes, and 60% of the patients had final visual acuity improved by 2 lines or more over that before their macular hole repair. CONCLUSION: Retinal detachment is a complication of macular hole surgery. These detachments tend to occur within the first 2 months of follow-up, and have a high success rate of anatomic reattachment with surgery. The occurrence of RD does not preclude improved final visual acuity.     

Clinical characteristics and surgical outcomes of pediatric rhegmatogenous retinal detachment in Taiwan

PURPOSE: To evaluate the clinical features and surgical and visual outcomes of rhegmatogenous retinal detachment (RRD) in the pediatric population. DESIGN: Retrospective, noncomparative, interventional case series. METHODS: A review of patients under 18 years who underwent primary retinal detachment surgery at National Taiwan University Hospital from 1989 to 2003 was conducted. RESULTS: Included in the study were 152 eyes of 146 patients (mean age of 13.1 years). Male patients comprised 69.9% of the sample. Bilateral RRD was present in 4.1%. Etiologies included myopia >4 diopters (37.5%), trauma (32.9%), developmental anomaly (11.8%), previous surgery (5.9%), previous uveitis (3.9%), atopic dermatitis (2.6%), and unknown (5.3%). Macular detachment was found in 73.0%. The most common primary treatment was scleral buckling (61.2%). Single-operation reattachment was accomplished in 58.5% of patients and eventual reattachment in 78.3% of patients occurring in a mean of 1.5 (SD = 0.9) operations. Average postoperative follow-up time was 48.3 months. Visual improvement occurred in 42.8%, remained the same in 32.2%, and worsened in 19.1%. In the logistic regression model, statistically significant risk factors for poor surgical outcome were nonmyopic RRD (P = .026), macular involvement (P = .01), and presence of proliferative vitreoretinopathy (P = .07). CONCLUSIONS: Myopia >4 diopters was the most common etiology in retinal detachment in our sample, followed by trauma. Myopia (> -4.0 diopters) may be more common than previously reported. Most eyes (78.3%) were anatomically reattached after multiple surgeries. Retinal detachment not associated with myopia is a newly identified predictor for poor surgical outcomes.     

合并脉络膜脱离的孔源性视网膜脱离临床特点及手术疗效分析

目的:分析合并脉络膜脱离的裂孔性视网膜脱离的临床特点及手术治疗效果。方法:合并脉络膜脱离的裂孔性视网膜脱离患者64例64眼,26例行巩膜扣带术,38例行玻璃体视网膜手术,术中均不行巩膜外冷凝,观察眼部表现及手术复位率等情况,分析合并脉络膜脱离的裂孔性视网膜脱离临床特点。结果:本组病例>-6.00D高度近视占总病例数的41%。64例合并脉络膜脱离的孔源性视网膜脱离均有葡萄膜炎反应,眼压2.00～8.00mmHg;26例行巩膜扣带术,19例视网膜复位,复位率73%,行玻璃体视网膜手术38例,32例视网膜复位,一次手术复位率84%。结论:合并脉络膜脱离的孔源性视网膜脱离高度近视眼、人工晶状体眼及无晶状体眼多发,视网膜光凝替代术中巩膜外冷凝可能提高视网膜复位率及减少术后复发率。     

Surgical outcomes in juvenile retinal detachment

PURPOSE: To evaluate retrospectively clinical features and surgical outcomes of rhegmatogenous retinal detachment in juvenile patients. METHODS: Between 1991 and 1996, 28 patients younger than 15 years of age with rhegmatogenous retinal detachment (32 eyes) underwent the first surgical procedure, scleral buckling and/or pars plana vitrectomy, at our hospital. RESULTS: The major types of juvenile detachment, in order of frequency, were idiopathic, familial exudative vitreoretinopathy, trauma, and high myopia. Proliferative vitreoretinopathy (PVR) of grade C or D was involved in 12 cases (37.5%). Among the 12 eyes with PVR, 7 attained retinal reattachment after the first surgery with scleral buckling. The overall reattachment rate was 28/32 (87.5%) after the first operation and 30/32 (93.8%) after the second operation. CONCLUSION: These findings indicate that the reattachment rate and visual prognosis can be as good in juvenile retinal detachment as in adult cases, when appropriate surgical procedures are used.     

Characteristics of rhegmatogenous retinal detachment

Characteristics of rhegmatogenous retinal detachment and its predisposing factors were studied in a consecutive series of 342 patients operated on for retinal detachment (RD) at the University Eye Hospital in Helsinki in 1978-1981. On these, 234 were pre-operatively examined and operated on by the senior author. The mean age of the patients was 52.8 +/- 1.0 (range 5.7 to 83.0) years, 49.1% were males, 50.9% females. Bilateral RD occurred in 9.9%, and another 4.7% had been treated for retinal breaks in the fellow eye. Of the main predisposing factors, myopia (greater than or equal to -1.0 D) was found in 50.6% of the phakic eyes, 23.0% of the eyes were aphakic, and lattice degeneration was found in 15.1% and trauma in 11.9% of the whole series. In the nontraumatic phakic group, lattice degeneration was present in 31.3%. In the aphakic group, 25.9% had underlying myopia and 8.1% showed lattice degeneration. The relative importance of these factors varied with age. Total RD was found in 60 eyes (17.0%), most commonly in aphakic eyes (32.1%). Macula was detached in 56.5%. Two or more retinal breaks were found in 40.9%. The type of breaks varied with age and refraction. Oral dialysis was common before the age of 20 in non-myopic phakic eyes. Between 20 and 39 years, tears and holes were equally common, and after 40 years of age tears predominated. Tears outnumbered holes both in nonmyopic and myopic eyes, most round holes were found in myopic eyes. In 11.6% of the eyes no sure retinal breaks were detected. Relation of retinal breaks to peripheral retinal degenerations was studied.     

玻璃体手术治疗严重增生性糖尿病视网膜病变合并视网膜脱离的效果

目的探讨玻璃体手术治疗严重的增生性糖尿病视网膜病变合并视网膜脱离的疗效及影响视力预后的因素。设计回顾性病例系列。研究对象北京同仁医院2004年3月-2007年3月间行玻璃体手术治疗的87例(95眼)糖尿病视网膜病变Ⅵ期患者。方法回顾上述患者住院病历,均采用传统的三通道玻璃体手术治疗,术后平均随访时间26个月,观察术后视力及眼部并发症发生情况,分析影响视力预后的相关因素。主要指标视力及眼部并发症。结果术后83眼(87%)视网膜复位。视力较术前提高44眼(46.3%),不变16眼(16.8%),下降35眼(36.8%)。手术前后视力差异有统计学意义(P=0.012)。其中60眼视网膜脱离累及黄斑,术后45%的眼视力下降。术后继发新生血管性青光眼7眼(7.4%),角膜失代偿1眼(1.1%),晶状体混浊加重52眼(54.7%)。结论玻璃体切除术治疗严重的增生性糖尿病视网膜病变合并视网膜脱离是有效的,视网膜脱离是否累及黄斑是影响视力预后的最重要的因素。     

Characteristics of retinal detachment in children

INTRODUCTION: Pediatric retinal detachments differ from adult retinal detachments in their etiologies, prognosis and treatment. The aims of this study were the analysis and long-term follow-up of a group of pediatric retinal detachment patients. PATIENTS AND METHODS: All the cases of juvenile retinal detachments treated in our department between 1987 and 1999 were retrospectively studied. The age at the time of diagnosis, etiology, initial topography of the detachment, treatments undertaken, follow-up, and final results were recorded. RESULTS: The study investigated 64 eyes of 53 children. The follow-up was longer than 6 months for 31 eyes, with a mean follow-up of 39.5 months. The main etiologies were traumatism, high myopia, and affections leading to an exudative retinal detachment such as retinoblastoma and Coats disease. Circular scleral buckling was often used because of the vitreous cohesiveness in children. A vitrectomy was frequently associated to treat severe proliferative vitreoretinopathy. The final visual acuity was higher than 0.05 in 32% of the cases. DISCUSSION: The etiological features, late diagnosis and frequency of proliferative vitreoretinopathy are responsible for the greater severity of retinal detachments in children. These factors associated with amblyopia lead to poor visual prognosis. CONCLUSION: Retinal detachment in children remains a severe pathology. However the prognosis seems to be improving with progress in examination techniques and surgery methods.