Rhegmatogenous retinal detachment in children 16 years of age or younger

A COMPARATIVE ANALYSIS OF TRAUMATIC RETINAL DETACHMENT AFTER OPEN AND CLOSED GLOBE INJURIES IN CHILDREN

PURPOSE

Pediatric traumatic retinal detachment (RD) resulting from open globe injuries (OGIs) or closed globe injuries (CGIs) presents unique challenges due to complexity often resulting in lifelong sequelae. This study compares pediatric traumatic RD outcomes and prognostic factors following OGI and CGI.

METHODS

A retrospective analysis reviewed 47 cases of pediatric traumatic RD in children (age <18 years), who underwent RD surgery between 2002 and 2021. Among them, 25 cases were caused by CGI and 22 cases by OGI. Demographics, RD characteristics, surgical procedures, and anatomical and functional results were assessed. Predictive factors for visual outcomes were investigated.

RESULTS

In the CGI group, mean (±SD) age was 11 years ± 4 years, and 10 years ± 5 years in the OGI group. Closed globe injury traumatic RD had significantly better preoperative (CGI: logarithm of the minimum angle of resolution 1.39 ± 0.19 (mean ± standard error); OGI: logarithm of the minimum angle of resolution 2.12 ± 0.20) and follow-up (CGI: logarithm of the minimum angle of resolution 0.94 ± 0.19; OGI: logarithm of the minimum angle of resolution 1.85 ± 0.20) best-corrected visual acuity (BCVA) ( P < 0.05). Initial BCVA improvement was observed in CGI only. In multivariable analysis, prognostic factors for favorable BCVA outcomes included higher preoperative BCVA, older age, and absence of proliferative vitreoretinopathy ( P < 0.05).

CONCLUSION

Visual prognosis for pediatric traumatic RD remains limited, favoring CGI cases compared with OGI. Baseline BCVA emerged as a major determinant of final visual acuity. Tailored management approaches can optimize treatment results.

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.

Vitrectomy for Complicated Retinal Detachment Without the Use of Perfluorocarbon Liquid: A Real-World Data and Retrospective Study

Introduction

This study aimed to evaluate the effectiveness of vitrectomy without using perfluorocarbon liquid (PFCL) for the treatment of complicated retinal detachment (RD).

Methods

The utilisation of PFCL was calculated in four hospitals in 2020 and in one hospital every year from 2012 to 2020. A case series of 320 RD eyes treated with vitrectomy without the use of perfluorocarbon liquid (VWTPL) was followed up for 1–26 months. The rate of retinal reattachment (RR) and postoperative visual acuity (VA, LogMAR) was evaluated. Furthermore, factors influencing RR and VA were analysed.

Results

The overall utilisation of PFCL was 43.87% (42.74%, 45.83%, 62.39% and 4.5%). The annual utilisation was 46.94%, 20.43%, 46.73%, 47.41%, 20%, 17.24%, 7.60%, 10.67% and 4.49% from 2012 to 2020. The VA of 320 eyes improved from 1.96 ± 1.07 preoperatively to 1.43 ± 0.92 (LogMAR, p < 0.001) 1 week post-operation. In the follow-up of 1–26 months (median: 9 months), the primary and final RR was 87.37% and 95.56%, respectively. Age, uveitis, recurrent RD, the number of detached retinal quadrants, aPVR and preoperative VA were considered as the factors influencing postoperative VA. Moreover, preoperative VA and preoperative intraocular pressure were the factors influencing RR.

Conclusion

The utilisation of PFCL varies amongst hospitals with a highest percentage of 62.39%. VWTPL is safe and effective, thereby saving costs and preventing complications related to PFCL.

Trial Registration

ChiCTR-ORC-17014225.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40123-022-00479-x.

Effects of the Pars Plana Vitrectomy on the Chronic Total Rhegmatogenous Retinal Detachment in the Young Adults

Objective: To observe the characteristics and evaluate the efficacy and safety of the chronic total rhegmatogenous retinal detachment (RRD) treatment by the 23-gauge pars plana vitrectomy (PPV) in young adults and to analyze the related factors. Methods: A retrospective chart review was performed for the young adults who underwent the 23-gauge PPV for the chronic total RRD at the Tianjin Medical University General Hospital from 2011 to 2018. A total of 54 eyes of 48 patients were included in this study. The preoperative vision ranged from 2.00 to 1.00. The mean duration of RRD was 9 ± 0.6 months with a range from 4 to 18 months. The proliferative vitreoretinopathy (PVR) grade D1 and grade D2 was diagnosed in 48 eyes and 6 eyes, respectively. About 37 eyes were filled with C3F8 and 17 eyes were filled with silicone oil tamponade. The follow-up ranged from 9 to 78 months with a mean of 23 ± 2.2 months. Results: The postoperative visual acuity increased in all the eyes at the final observation. The retinal attachment was achieved in 49 eyes (90.7%) in the primary PPV. Five eyes (9.3%) with the failed retinal attachment finally achieved the attachment after the second procedure. The postoperative complications mainly included temporary intraocular pressure (IOP) elevation, hyphema, and retinal redetachment. Conclusion: Chronic total RRD can be treated via the 23-gauge PPV with a great anatomical and visual prognosis in the young adult. The successful treatment of the chronic total RRD in young adults is mainly associated with the complete dissection of the severe vitreoretinopathy, especially for the epiretinal membrane at the retinal breaks and degenerations and the subretinal proliferation during surgery.

Pars Plana Vitrectomy vs Combined Pars Plana Vitrectomy-Scleral Buckle for Primary Repair of Pediatrics Retinal Detachment

Purpose

To evaluate the outcome of pars plana vitrectomy (PPV) and combined pars plana vitrectomy with scleral buckle (PPV-SB) in the primary pediatrics rhegmatogenous retinal detachment repair.

Design

A retrospective cohort study.

Methods

A retrospective study was conducted in patients under 18 years of age, who presented with rhegmatogenous retinal detachment at King Khaled Eye Specialist Hospital between January 2014 and October 2018. Primary measurable outcomes were single surgery success rate (SSSR) and rate of postoperative complications.

Results

A total of 122 eyes of 117 patients were included in the study; 80 eyes in PPV group and 42 eyes in PPV-SB group. Mean follow-up period after surgery was 18.2 months ±11 months. SSSR was 76.3% (n=61) and 66.7% (n=28) for PPV and PPV-SB, respectively. No statistically significant difference was found between the two methods of RRD repair in single surgery success rate with an OR of 1.3 (P=0.45). Complication rates were comparable in both groups in the last follow-up.

Conclusion

In this series, PPV and PPV-SB have comparable results in regard to anatomical success and rate of postoperative complications. More complicated cases were selected to undergo PPV-SB upon surgeons' preference.

Pediatric rhegmatogenous retinal detachment: predictors of anatomic and functional success

PURPOSE

This study describes presenting clinical features and surgical techniques associated with successful repair of pediatric rhegmatogenous retinal detachment (RRD).

METHODS

This is a retrospective case series which involved 242 cases younger than 18 years with new-onset RRD with descriptive statistics for the full group. Further exclusion established 168 cases that underwent surgery with minimum 3-month follow-up. Comparison of features associated with successful outcomes was analyzed using Chi-squared tests, logistic regression and univariate generalized equation models.

RESULTS

We measured proportion of patients with BCVA ≤ 1.0 logMAR and/or an increase in final BCVA of 0.3 logMAR with respect to baseline and complete reattachment at final visit; 104 eyes (62%) achieved total reattachment, and 91 eyes (54%) achieved visual success. Absence of macular involvement, subtotal RRD and older age group (13-18) were associated with both success measures. There were higher visual and anatomic success rates with primary scleral buckling (SB, 66% and 79%; OR 9.26 and 11.09) and combined SB plus pars plana vitrectomy (PPV, 54% and 58%; OR 5.67 and 3.94) compared with PPV alone (26% and 17%).

CONCLUSION

A majority of patients achieved anatomical success with repair. Trauma and myopia were the most common etiologic associations, with myopic cases having better outcomes. Success was more likely in patients with subtotal RRD or uninvolved macula at presentation; previous intraocular surgery was a risk factor for failure. Younger patients had a higher likelihood of worse outcomes. Initial PPV showed a lower rate of success than either SB or combined SB/PPV.

Analysis of Etiologic Factors in Pediatric Rhegmatogenous Retinal Detachment With Genetic Testing

PURPOSE

The purpose of this study was to investigate the etiology and clinical features of nontraumatic rhegmatogenous retinal detachment (RRD) in children.

DESIGN

Consecutive, cross-sectional study.

METHODS

In this study, 112 operative eyes of 102 patients ≤18 years of age with nontraumatic RRD were included. Comprehensive ophthalmic examinations were performed in all patients. Genetic testing was performed in 34 patients with hereditary congenital/developmental diseases. The etiology of RRD was analyzed.

RESULTS

The average age was 12.2 ± 4.5 years (range, 1-18 years). The percentages of male and female patients were 74.5% (76/102) and 25.5% (26/102), respectively. The most common etiologic factors were congenital/developmental anomalies (51/102, 50%), followed by simple myopia (34/102, 33.3%) and previous intraocular surgery (6/102, 5.9%). More than half (31/51, 60.8%) of the patients with congenital/developmental anomalies had familial exudative vitreoretinopathy. Further analysis of the underlying etiologic factors based on age revealed that the most common etiology of RRD in patients ≤12 years of age was congenital/developmental anomalies (28/48, 58.3%); however, simple myopia was the major etiologic factor in patients >12 years of age (27/54, 50%).

CONCLUSIONS

Congenital/developmental diseases were the most common etiologies of pediatric nontraumatic RRD in China. Familial exudative vitreoretinopathy accounted for most of the congenital/developmental anomalies.

[Retinal detachment in children and adolescents. Specific clinical features]

BACKGROUND

Due to the long life expectancy, retinal detachment is a special threat to visual acuity in children and adolescents. This study presents the clinical features of retinal detachment in childhood and adolescence up to the age of 20 years.

PATIENTS AND METHODS

A cohort was selected comprising 259 patients who suffered from unilateral or bilateral retinal detachment, were not older than 20 years of age at the first diagnosis of the first or only affected eye and had undergone surgery at least once at the Department of Ophthalmology of the University Medical Center of Munich during a period of 18 years (1980-1998). This patient collective was retrospectively analyzed with respect to the clinical features of the first retinal detachment. The group consisting of only one affected eye or the first affected eye (259 eyes) was included. The fellow eyes affected later were excluded (19 eyes).

RESULTS

The time period between the first visual symptoms and the diagnosis of retinal detachment was on average 9.6 weeks and the most commonly manifested symptom was loss of vision (36.3% of patients). In 40.2% of the patients the detachment was discovered fortuitously. The most frequent presentation (34.0%) was a 2-quadrant retinal detachment and was (sub)total in 27.0% of eyes. Macular detachment was found in 154 eyes (59.5%). The commonest type of retinal break was a tear near the ora serrata (36.1% of all breaks). Giant tears (12.8% of all breaks) occurred preferentially in the area of the ora serrata, round atrophic holes were identified especially in the area of the equator, often in the form of a chain of holes. Breaks most frequently occurred in the inferior temporal quadrant. In 22.4% of retinal detachments no break was found even intraoperatively. A primary proliferative vitreoretinopathy (PVR) of at least stage C was involved in 25.5% of detachments.

CONCLUSION

In childhood and adolescence a characteristic delay of diagnosis enables a large sized expansion of the retinal detachment with frequent macular involvement and a high proportion with (sub)total detachment and severe primary PVR. Tears in the ora serrata area, giant tears, multiple round atrophic holes in the area of the equator and a high rate of undetectable breaks are the intrinsic characteristics of juvenile retinal detachment.

RETINAL DETACHMENT SURGERY IN A PEDIATRIC POPULATION: Visual and Anatomic Outcomes

PURPOSE

Pediatric retinal detachments (RDs) are unique in etiology, anatomy, and prognosis compared with the adult population. The mechanisms of pediatric RD include tractional (TRD), rhegmatogenous retinal detachment, traumatic, and other types, such as exudative or hemorrhagic. This study examined visual and anatomical outcomes of pediatric RD undergoing surgical repair at a single university referral center.

METHODS

A retrospective consecutive case series of patients clinically diagnosed and undergoing surgery for RD between birth and 15 years of age from 2002 to 2013 at a single academic institution.

RESULTS

A total of 206 patients (231 eyes) were included in this study, of which 25 (12%) had bilateral RD. Of those patients, 67 (29%) had TRD (retinopathy of prematurity, persistent fetal vasculature, or familial exudative vitreoretinopathy), 51 (22%) had rhegmatogenous retinal detachment (myopia, X-linked retinoschisis, or Stickler syndrome), 60 (26%) had traumatic RD, and 53 (23%) were due to other types of RD, such as Coats disease or coloboma. Presenting best-corrected visual acuity better than 20/200 correlated with better final best-corrected visual acuity (P < 0.0001). Anatomical success was strongly correlated with visual acuity outcome (P < 0.00001) and was significantly more likely in rhegmatogenous retinal detachment versus TRD (78% vs. 39%, P < 0.05). The rates of obtaining a final best-corrected visual acuity > 20/200 were poorer in TRD (10%) compared with rhegmatogenous retinal detachment (39%, P < 0.01) or traumatic RD (28%, P < 0.05).

CONCLUSION

Visual and anatomical outcomes varied among categories of RD. Rhegmatogenous retinal detachments were associated with the best outcomes (anatomical success and globe conservation), whereas TRDs generally had poorer visual and anatomical outcomes.

Scleral buckling procedure with chandelier illumination for pediatric rhegmatogenous retinal detachment

Purpose

To assess the treatment of pediatric patients with rhegmatogenous retinal detachment (RRD) by scleral buckling with chandelier illumination.

Methods

Three eyes were treated in three patients, healthy boys aged 7 years, 12 years, and 11 years, with RRD, macular involvement, and small retinal holes, of which two were preoperatively undetectable. Conventional scleral buckling with cryoretinopexy was performed under the contact lens for vitreous surgery or noncontact wide-angle viewing system using 27-gauge twin chandelier illumination.

Results

The only known predisposing factor for retinal detachment was myopia stronger than 3 D with lattice retinal degeneration in two of the three patients. Retinal reattachment was achieved in all cases without intra- or postoperative complications. However, visual recovery was limited in one of the three patients.

Conclusion

Scleral buckling with chandelier illumination is effective for pediatric RRD, especially if the retinal hole is difficult to detect preoperatively. However, visual recovery was sometimes limited because of macular involvement due to late diagnosis, which is one of the characteristic features of pediatric RRD.