A 12-year review on the aetiology and surgical outcomes of paediatric rhegmatogenous retinal detachments in Hong Kong

Outcomes in Retinal Detachment Repair and Laser Prophylaxis for Syndromes with Optically Empty Vitreous

PURPOSE

To evaluate and compare surgical outcomes for syndromes with optically empty vitreous (SOEV)-associated rhegmatogenous retinal detachments.

DESIGN

A retrospective, cross-sectional, 2-arm study of a single pediatric vitreoretinal surgeon's patients from a quaternary referral center with SOEV was performed to examine visual and anatomical outcomes of rhegmatogenous retinal detachment and laser prophylaxis.

SUBJECTS

Patients identified either through slit-lamp examination (presence of an optically empty or void space in the vitreous gel structure) or genetic testing. Fifty-six eyes of 49 patients were identified in the retinal detachment arm. Sixty eyes of 48 patients were identified in the laser prophylaxis arm.

METHODS

Comparison of initial retinal detachment (RD) surgical repair via pars plana vitrectomy (PPV), scleral buckle (SB), or PPV-SB with final anatomical success, best-corrected visual acuity (BCVA), and number of surgical procedures. Secondary analysis was performed looking at eyes failing their initial SB, eyes with a giant retinal tear at presentation, eyes failing RD repair within specific time intervals, and eyes where hyaloid was elevated during initial vitrectomy. An additional study arm examined the outcomes of final BCVA and the presence and timing of developing a retinal tear or RD in eyes who received laser prophylaxis.

MAIN OUTCOME MEASURES

Visual acuity, surgical repair techniques (PPV, SB, PPV-SB), number of surgeries, anatomical retinal reattachment success.

RESULTS

Initial SB had statistically significant better final BCVA (P < 0.01) and better final anatomical success (P < 0.01). No statistical difference in the number of surgeries needed to achieve anatomical success between the initial SB versus initial PPV-SB/PPV. Hyaloidal elevation during the initial vitrectomy was associated with improved final BCVA and higher final anatomical success without the use of silicone oil (P < 0.01 and 0.04 respectively). Lastly, eyes that developed RDs after laser prophylaxis had better final BCVA than untreated eyes (P < 0.05).

CONCLUSION

Initial SB yields better overall outcomes in SOEV presenting with rhegmatogenous retinal detachment. Stickler Type-1 patients had similar outcomes compared with other SOEV, suggesting both populations should be treated with similar approaches.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Re-Vitrectomy versus Combined Re-Vitrectomy with Scleral Buckling for Pediatric Recurrent Retinal Detachment

Purpose

To compare re-vitrectomy versus combined re-vitrectomy with scleral buckling (SB) for pediatric recurrent rhegmatogenous retinal detachment (RRD) following failed primary pars plana vitrectomy (PPV).

Methods

This was a retrospective, comparative case series of pediatric patients (under 18 years) who underwent secondary RRD procedures after failed primary PPV. Patients were divided into the re-vitrectomy and the combined re-vitrectomy with SB groups. The primary outcome was the anatomical success rate for each procedure. The secondary outcomes were changes in best-corrected visual acuity (BCVA) and postoperative complications.

Results

In the re-vitrectomy group (30 eyes), the final anatomical success rate was 83.3% (25/30) after a mean follow-up of 21.7 + 6.9 months. The final anatomical success rate in the combined re-vitrectomy/SB group (23 eyes) was 73.9% (17/23) after a mean follow-up of 26.5 + 7.7 months. There was no statistically significant difference in the final anatomical success rate (P = 0.41) and the mean change in BCVA (P = 0.37) between the two groups. Even though not statistically significant, the combined re-vitrectomy/SB group had a lower incidence of postoperative complications (P = 0.25).

Conclusion

Re-vitrectomy alone provides similar anatomical and functional outcomes to combined re-vitrectomy/SB for pediatric recurrent RRD after failed primary PPV.

[Primary Diseases of 393 Cases of Pediatric Retinal Detachment and the Distribution of Clinical Characteristics]

OBJECTIVE

To investigate the primary diseases and the distribution of the clinical characteristics of pediatric retinal detachment.

METHODS

Clinical records of patients aged 0-14 years old who had retinal detachment and who were hospitalized at the Department of Ophthalmology, West China Hospital, Sichuan University between January 2015 and December 2020, were retrospectively analyzed. The information on the demographic data, history, the scope of retinal detachment, and prognosis was retrieved and documented.

RESULTS

A total of 464 eyes of 393 patients were included in this study, including 261 male and 132 female patients at a ratio of 1.98:1. The most common type of primary disease causing pediatric retinal detachments was associated with ocular dysplasia (227 cases, 57.8%), followed by trauma (78 cases, 19.8%) and myopia (56 cases, 14.2%). For infants and preschool children, the primary disease was predominantly ocular dysplasia at a rate of 81.8% (126 cases) and 55.8% (43 cases), respectively. For school-age children, in addition to ocular dysplasia (58 cases, 35.8%), myopia (49 cases, 30.2%) and ocular trauma (43 cases, 26.5%) also accounted for a large proportion of the primary diseases. The most common type of pediatric retinal detachment was rhegmatogenous retinal detachment (184 cases, 46.8%), and ocular trauma and myopia were the most common primary diseases, accounting for 37.5% (69/184) and 30.4% (56/184), respectively. 170 patients were diagnosed with traction retinal detachment, the second most common type of pediatric retinal detachment, and familial exudative vitreoretinopathy (FEVER) was the main primary disease, accounting for 47.6% (81/170). Exudative retinal detachment (39 cases, 9.9%) was the least common type of pediatric retinal detachment. Coats disease was the main primary disease causing exudative retinal detachment, accounting for 71.8% (28/39). After the first repair surgery, patients who had complete traction retinal detachment generally had poorer anatomical outcomes compared with those with complete rhegmatogenous retinal detachments (| Z|=3.026, P=0.002). The retinal break was most commonly seen on the temporal side in pediatric rhegmatogenous retinal detachments. In the retinal detachments caused by trauma, the most common type of retinal break was retinal tear, followed by ora serrata dialysis. Myopic rhegmatogenous retinal detachments were most commonly found in the round holes in lattice degeneration region.

CONCLUSION

In the current study, boys were found to be more susceptible to retinal detachment than girls did. Ocular dysplasia, ocular trauma and myopia were major etiologic factors for pediatric retinal detachment. Appropriate information and education measures should be emphasized for different age groups.

PEDIATRIC RETINAL DETACHMENT IN AN ASIAN POPULATION WITH HIGH PREVALENCE OF MYOPIA: Clinical Characteristics, Surgical Outcomes, and Prognostic Factors

PURPOSE

To evaluate the clinical characteristics and surgical outcomes of pediatric retinal detachments (RDs) in an Asian population.

METHODS

Retrospective review of 171 eyes of 152 pediatric patients with rhegmatogenous RD over a 20-year period.

RESULTS

Myopia was the most common risk factor in our population. At 6 months, primary anatomical success was 60.7%, and overall anatomical success was 86.7%. A total of 46.8% had best-corrected visual acuity of 20/40 or better, and 81.6% had best-corrected visual acuity of 20/200 or better. In primary RDs, high myopia (≤-6D) patients had a lower primary anatomical success compared to patients with moderate myopia (≤-2D) (59.3 vs. 100% P = 0.03). Increasing age and absence of proliferative vitreoretinopathy were associated with anatomical and visual success. Pars plana vitrectomy as the primary procedure was associated with decreased odds of anatomical success. A longer duration of symptoms, cataract, and a larger RD extent were associated with poorer functional outcome.

CONCLUSION

Myopia was the commonest risk factor for pediatric RD in our population. Good anatomical and functional outcome can be achieved with surgery. Increasing age at presentation and absence of proliferative vitreoretinopathy was associated with anatomical and functional success. High myopia was associated with poorer anatomical and functional outcome.

The Association with rhegmatogenous retinal detachment and paediatric atopic dermatitis: a 12-year Nationwide Cohort Study

PURPOSE

Historically, atopic dermatitis (AD) is associated with an increased risk of rhegmatogenous retinal detachment (RRD). However, uncertainty remained regarding the effect of AD itself and comorbidities (e.g., allergic diseases, cataract surgery) on RRD occurrence in a large, population-based paediatric population.

PATIENTS AND METHODS

We analysed the 12-year National Health Insurance Service database (2002-2013) covering the entire Korean population to estimate the association between AD and RRD in people aged under 20 years.

RESULTS

We identified 3142 RRD patients, and matched 18,852 controls (six controls to each RRD patient); therefore, we included 21,994 peoples under aged 20 years in the analyses. AD was more prevalent in the RRD group (329 patients, 10.47%) than the control group (1043 patients, 5.53%; P < 0.001), and so were severe AD (153 patients [4.87%] and 223 patients [1.18%], respectively; P < 0.001). In conditional logistic regression analysis, AD was associated with RRD (OR, 1.61; 95% CI, 1.93-1.87) even after adjusting for allergic conditions, connective tissue disease, uveitis, and cataract surgery. In addition, severity of AD was associated with an increased risk of RRD (OR for non-severe AD and severe AD, 1.26 [95% CI, 1.05-1.51] and 2.88 [95% CI, 2.25-3.68]).

CONCLUSION

This study suggests that AD itself is a risk factor of RRD in children by showing the association between AD and RRD occurrence and the biologic gradient even after adjustment for known confounders including allergic conditions, uveitis, and cataract surgery.

Causas del desprendimiento de retina y el desenlace visual final en menores de 18 años en el Hospital San Vicente Fundación

Objetivo: caracterizar las causas del desprendimiento de retina y determinar la agudeza visual final en menores de 18 años en el Hospital San Vicente Fundación entre 2012 y 2017.Metodología: se realizó un análisis retrospectivo de historias clínicas de pacientes con diagnóstico de desprendimiento de retina confirmado por examen oftalmológico o ecografía, se incluyeron pacientes menores de 18 años que ingresaron al Hospital San Vicente Fundación entre 2012 y 2017 para identificar las causas del desprendimiento de retina y la agudeza visual final.Resultados: se analizaron 51 historias clínicas: 28 hombres y 23 mujeres, 39,1 % ocurrieron en menores de 1 año y no se encontró desprendimiento de retina por encima de los 14 años. Las causas se establecieron como retinopatía de la prematuridad 23,5 %, trauma ocular 21,6 %, retinoblastoma 9,8 %, toxoplasmosis congénita 7,8 %, toxocara 7,8 %, entre otras, no se encontró causa en 3,9 % de los pacientes.En 50 ojos de 41 pacientes se determinó la agudeza visual final, de los cuales 47 (94 %) quedaron con agudeza visual peor o igual a 20/200 y 3 ojos con agudeza visual de 20/40 o mejor.Discusión: el desprendimiento de retina es infrecuente en los niños, sin embargo, sus causas y desenlaces son más devastadores que en los adultos. En nuestro medio las principales causas son la retinopatía de la prematuridad, el trauma, el retinoblastoma y las infecciones parasitarias. Diferente a los adultos, en los niños se requiere una evaluación más cuidadosa y un umbral de sospecha más bajo para considerar enfermedades potencialmente mortales.

Adjunctive dexamethasone implant in patients with atopic dermatitis and retinal detachment undergoing vitrectomy and silicone oil tamponade: an interventional case series

Background

To report the clinical course and outcomes of adjunctive dexamethasone implants in patients with atopic dermatitis (AD) and retinal detachment (RD) undergoing vitrectomy and silicone oil tamponade.

Methods

This retrospective, interventional case series included AD patients with RD and various degrees of proliferative vitreoretinopathy (PVR) who were scheduled to undergo vitrectomy. Following total vitrectomy and retinopexy, silicone oil tamponade was performed. Finally, an intraocular dexamethasone implant was injected intravitreally. Anatomical and functional outcomes were assessed at 12 months, and extended follow-up data were also collected.

Results

Seven eyes from six patients (five male, one female) were included. The median age was 29 (range, 20–38) years. Preoperatively, six eyes were pseudophakic, two eyes had a history of previous vitreoretinal surgery, and one had uveitis. Postoperatively, best-corrected visual acuity improved in two eyes, worsened in one, and remained similar in four. Retinal attachment was maintained in all eyes at 12 months. The major complication was an increase in postoperative intraocular pressure in six eyes, requiring either medical or surgical treatment. During the extended follow-up period (15–37 months), retinas remained attached in all eyes and stable visual acuity was maintained in five.

Conclusions

Injection of an intraoperative dexamethasone implant to silicone oil-filled eyes appears tolerable and may be beneficial in the surgical management of AD patients with RD and PVR.

Case Series: Bilateral Rhegmatogenous Retinal Detachments in Atopic Dermatitis

SIGNIFICANCE

Bilateral occurrence of rhegmatogenous retinal detachment is a potentially blinding condition seen most commonly in patients with atopic dermatitis. Poor control of the skin condition may lead to simultaneous or sequential retinal detachment and even development of complications such as proliferative vitreoretinopathy.

PURPOSE

The purpose of this study was to highlight the importance of the dermatologist's role in aggressive treatment of atopic dermatitis to prevent this potentially blinding condition.

CASE REPORTS

A retrospective review of three patients with poorly controlled atopic dermatitis at the Singapore National Eye Centre with bilateral rhegmatogenous retinal detachment was conducted. Two patients presented with sequential rhegmatogenous retinal detachments, and one patient had simultaneous bilateral retinal detachments. At presentation, all three were experiencing atopic dermatitis flares and were either on low-dose oral or topical steroids only. Post-retinal detachment surgery, all eyes except one achieved good visual acuity. The patients were referred to a dermatologist and treated with therapeutic doses of systemic steroids and immunomodulators for their dermatitis flare.

CONCLUSIONS

This case series draws attention to the importance of the eye care provider's comanagement of such patients with atopic dermatitis. Aggressive control of facial atopic dermatitis with consideration of immunomodulators or short-term systemic steroids during flares to control facial eczema and eye rubbing may reduce this potentially blinding ocular complication.

Retinal Detachment Associated With Atopic Dermatitis

Ocular manifestations related to atopic dermatitis include keratoconus, keratoconjunctivitis, cataract, and retinal detachment. The authors report three cases of retinal detachment associated with atopic dermatitis. Although the pathogenesis is poorly understood, chronic blunt trauma may play a role in the development of retinal detachment. In addition, retinal detachments associated with atopic dermatitis may have lower rates of successful retinal detachment repair. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:513-517.].