Silvia Bopp (Bremen, Germany)

Advantages:

To evaluate the etiologies, treatment and surgical outcomes of rhegmatogenous retinal detachment (RRD) in children and adolescents (up to 18 years) and to highlight the specific features that are different from adult RRD.

Methods:

Retrospective chart review of 55 eyes (50 patients) with RRD between 2000 and 2010. Only 10 eyes showed RRD without any identifiable risk factor (idiopathic). The remaining 82% had either ocular risk factors (ocular trauma, myopia, lattice degeneration, history of ROP, previous lens surgery), ocular developmental anomalies (Wagner syndrome, anterior PFS, coloboma) or systemic risk factors (Marfan and Down syndrome, Down, autism). Almost half of the eyes had more than one predisposing condition. At initial presentation, 16.4% had advanced PVR. Major hole types were ora dialysis (29%), atrophic hole (25%) and giant tear (9%). In 19% no causative retinal defect could be identified, especially in eyes with long-standing RRD and PVR. Dependent on the clinical situation, 72% of eyes with RRD/no PVR had buckling surgery while 28% had primarily vitreous surgery. All eyes with PVR underwent vitrectomy with silicone oil tamponade. Primary success rates of the subgroups were 70%, 15.4% and 33%, respectively with a final success of 92%. Significant visual improvement was achieved in eyes with 1° success, while function was stabilized at a low level in eyes that were reattached after revision surgeries.

Effectiveness / Safety:

Pediatric RRDs differ from adult RRD in many respects: heterogeneity of etiologies, special types of holes and a high rate of primary and postoperative PVR. Furthermore, anatomic success and functional outcomes are less favorable, in particular when reattachment could not be achieved with single surgery. Delayed initial presentation due to young age or disability, long-standing macula-off RRD, complex anatomic situations as a result of ocular and systemic co-morbidities and the juvenile vitreous are crucial points that affect the postoperative outcomes.

Take home message:

Eyes with a clear retinal situation and small tears most likely will have successful buckling surgery. Postoperative prognosis correlates negatively with the size of the tear, the complexity of the detachment and the presence of PVR. RRD associated with congenital and developmental anomalies will most likely require innovative, individualized treatment concepts.