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Yu J, Hu X, Zhang J, Han H, Huang B, Brant R, Zhang C, Yan H. Effects of the Pars Plana Vitrectomy on the Chronic Total Rhegmatogenous Retinal Detachment in the Young Adults. Front Med (Lausanne) 2021; 8:755389. [PMID: 34746192 PMCID: PMC8569252 DOI: 10.3389/fmed.2021.755389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Jinguo Yu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xingxing Hu
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Jiangkai Zhang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Han Han
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Bo Huang
- Department of Ophthalmology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Rodrigo Brant
- Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Cheng Zhang
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Hua Yan
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Molecular Ophthalmology, Tianjin Medical University, Tianjin, China
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Oku K, Tokutsu K, Matsuda S, Kondo H. Epidemiologic study of rhegmatogenous retinal detachment in Japan from the Diagnosis Procedure Combination database over a 2-year period (2014-2015). Jpn J Ophthalmol 2021; 65:797-802. [PMID: 34463875 DOI: 10.1007/s10384-021-00867-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 06/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the incidence of rhegmatogenous retinal detachments (RRDs) and proliferative vitreoretinopathies (PVRs) and their distribution by age and sex in hospitalized patients in Japan. STUDY DESIGN Retrospective nationwide observational study. METHODS Information on the number of inpatients primarily diagnosed with RRD or PVR and their age and sex were collected from the Diagnosis Procedure Combination (DPC) database for 2014 and 2015. The incidence was determined using the Japanese population report published by the Public Management Ministry's Statistics Bureau. RESULTS The incidence of RRD in these hospitalized patients was 10.9/100,000, with 15.0/100,000 in men and 7.1/100,000 in women, and that of PVR was 2.1/100,000, with 2.9/100,000 in men and 1.3/100,000 in women. The incidence in men was twice that in women for both RRD and PVR. The distribution of RRD by age was monophasic, with a peak at 50 years for both sexes, and that of PVR was at peak in the 60 s for men and in the 70 s for women. PVR was more common than RRD in children aged younger than 10 years, but the incidence of RRD was higher in the other age groups. CONCLUSION A study of the DPC database can provide useful information on the incidences of RRD and PVR in hospitalized patients in Japan.
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Affiliation(s)
- Kazuma Oku
- Department of Ophthalmology, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Yahatanishiku, Iseigaoka, Kitakyushu, 807-8556, Japan
| | - Kei Tokutsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Hiroyuki Kondo
- Department of Ophthalmology, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1 Yahatanishiku, Iseigaoka, Kitakyushu, 807-8556, Japan.
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Ghoraba HH, El Gouhary SM, Ghali AAA, Abdelhafez MA, Zaky AG, Leila M, Heikal MA, Mansour HO. Pars plana vitrectomy with/without encircling scleral band for treatment of retinal detachment associated with buphthalmos. Int J Retina Vitreous 2021; 7:39. [PMID: 33985587 PMCID: PMC8117629 DOI: 10.1186/s40942-021-00310-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 05/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background To evaluate the results of pars plana vitrectomy (PPV) and silicone oil (SO) tamponade with or without encircling scleral band for repair of rhegmatogenous retinal detachment (RRD) in children with buphthalmos. Patients and methods Retrospective comparative nonrandomized interventional case series including consecutive patients who underwent PPV with or without encircling band and SO tamponade for RRD associated with buphthalmos. Results The study included 19 eyes of 19 children. Mean age was 8 years, range 3–16 years. Mean follow-up period was 28 months, range 19–63 months. Globe survival has been achieved in 15 out of 19 eyes (79%). Phthisis bulbi was reported in four cases (22%). Eight patients (42%) achieved ambulatory vision. Most eyes initially achieved anatomical success. Conclusion Despite the poor visual and anatomical results of RRD repair in eyes with buphthalmos, globe survival might be the rationale for surgery in such cases. Globe preservation could avoid the psychological and social consequences of phthisis bulbi in non-operated children.
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Affiliation(s)
- Hammouda Hamdy Ghoraba
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.,Magrabi Eye Hospital, Tanta, Egypt
| | - Sameh Mohamed El Gouhary
- Ophthalmology Department, Faculty of Medicine, Menoufia University, Shibīn al-Kawm, Menoufia, Egypt
| | - Ali Ahmed Ali Ghali
- Ophthalmology Department, Faculty of Medicine, Al-Azhar University, Damietta Branch, New Damietta, Egypt
| | | | - Adel Galal Zaky
- Ophthalmology Department, Faculty of Medicine, Menoufia University, Shibīn al-Kawm, Menoufia, Egypt
| | - Mahmoud Leila
- Retina Department, Research Institute of Ophthalmology, Giza, Egypt
| | - Mohamed Amin Heikal
- Ophthalmology Department, Faculty of Medicine, Benha University, Banha, Egypt.,Magrabi Eye Hospital, Eastern Province, Kingdom of Saudi Arabia
| | - Hosam Othman Mansour
- Magrabi Eye Hospital, Tanta, Egypt. .,Ophthalmology Department, Faculty of Medicine, Al-Azhar University, Damietta Branch, New Damietta, Egypt.
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Al Taisan AA, Alshamrani AA, AlZahrani AT, Al-Abdullah AA. Pars Plana Vitrectomy vs Combined Pars Plana Vitrectomy-Scleral Buckle for Primary Repair of Pediatrics Retinal Detachment. Clin Ophthalmol 2021; 15:1949-1955. [PMID: 34007147 PMCID: PMC8121681 DOI: 10.2147/opth.s305910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/12/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Abdulaziz A Al Taisan
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Surgery Department, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
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Pediatric rhegmatogenous retinal detachment: predictors of anatomic and functional success. Int Ophthalmol 2021; 41:2777-2788. [PMID: 33840049 DOI: 10.1007/s10792-021-01834-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
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.
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Abdullatif AM, Macky TA, Mortada HA. Extended Internal Limiting Membrane Peeling in Complex Pediatric Rhegmatogenous Retinal Detachment. Ophthalmologica 2020; 244:223-228. [PMID: 33045707 DOI: 10.1159/000512194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/07/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the feasibility and investigate the anatomical and functional outcomes of extended internal limiting membrane (ILM) peeling with pars plana vitrectomy (PPV) for complex pediatric rhegmatogenous retinal detachment (RRD). METHODS This was a retrospective interventional case series where children (≤18 years) with RRD and severe PVR (grade C) were included. All eyes underwent PPV with ILM peeling up to 2-disk diameter beyond the vascular arcades. The main outcome measures were assessment of feasibility of ILM peeling in the pediatric RRD and evaluation of the rate of complete retinal reattachment and corrected-distance visual acuity (CDVA) at the final follow-up. RESULTS A total of 29 eyes (25 patients) were enrolled in this study. ILM peeling performed on these children was not more difficult than in adult eyes. After a mean follow-up of 18 months, the patients achieved final CDVA better than 20/200 in 37.9%. The initial retinal reattachment was 55.2% while the final anatomical success was 86.2%. CONCLUSION Vitrectomy with ILM peeling is technically feasible in pediatric RRD, limiting epiretinal proliferation and achieving favorable anatomical outcomes in cases of complex pediatric RRD. The long-term effects of ILM peeling need further investigation.
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Affiliation(s)
- Abdussalam M Abdullatif
- Department of Ophthalmology, Kasr El Aini Hospital, Cairo University, El-Manial, Cairo, Egypt
| | - Tamer A Macky
- Department of Ophthalmology, Kasr El Aini Hospital, Cairo University, El-Manial, Cairo, Egypt
| | - Hassan A Mortada
- Department of Ophthalmology, Kasr El Aini Hospital, Cairo University, El-Manial, Cairo, Egypt
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Chen C, Huang S, Sun L, Li S, Huang L, Wang Z, Luo X, Ding X. Analysis of Etiologic Factors in Pediatric Rhegmatogenous Retinal Detachment With Genetic Testing. Am J Ophthalmol 2020; 218:330-336. [PMID: 32112773 DOI: 10.1016/j.ajo.2020.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/08/2020] [Accepted: 02/13/2020] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Chonglin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Sijian Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Limei Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Songshan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Li Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Zhirong Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoling Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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Abstract
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.
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Chen C, Wang Z, Sun L, Huang S, Li S, Zhang A, Luo X, Huang L, Ding X. Next-Generation Sequencing in the Familial Exudative Vitreoretinopathy-Associated Rhegmatogenous Retinal Detachment. ACTA ACUST UNITED AC 2019; 60:2659-2666. [DOI: 10.1167/iovs.19-26619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Chonglin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, SunYat-Sen University, Guangzhou, China
| | - Zhirong Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, SunYat-Sen University, Guangzhou, China
| | - Limei Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, SunYat-Sen University, Guangzhou, China
| | - Sijian Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, SunYat-Sen University, Guangzhou, China
| | - Songshan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, SunYat-Sen University, Guangzhou, China
| | - Aiyuan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, SunYat-Sen University, Guangzhou, China
| | - Xiaoling Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, SunYat-Sen University, Guangzhou, China
| | - Li Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, SunYat-Sen University, Guangzhou, China
| | - Xiaoyan Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, SunYat-Sen University, Guangzhou, China
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TWENTY-FIVE-GAUGE PARS PLANA VITRECTOMY IN COMPLEX RETINAL DETACHMENTS ASSOCIATED WITH GIANT RETINAL TEAR. Retina 2018; 38:670-677. [PMID: 28333880 DOI: 10.1097/iae.0000000000001592] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To study the structural and functional outcomes of 25-gauge pars plana vitrectomy in giant retinal tear-associated retinal detachments. METHODS Seventeen eyes of 17 patients with giant retinal tear, who underwent 25-gauge pars plana vitrectomy over a period of 15 months at a tertiary eye care center by a single surgeon, were recruited in this retrospective interventional study. RESULTS Giant retinal tears were mostly traumatic (35.3%) or associated with myopia (35.3%) and occurred in young (mean age 25.7 years) males (94.1%). Most eyes had best-corrected visual acuity ≤20/1,200 (in 82.3%), foveal detachment (in 88.2%), and proliferative vitreoretinopathy ≤Grade B (in 82.3%). The giant retinal tear extent was more than 180° in 29.4% and the fellow eye was involved in 35.2% of eyes. All eyes underwent 25-gauge pars plana vitrectomy with encircling band in 41.1%, perfluorocarbon liquid use in 82.3%, and endotamponade with sulphur hexafluoride (23.6%) or silicone oil (76.4%). At mean follow-up of 10.2 months, reattachment rate was 88.2%. Only 35.2% of eyes achieved final visual acuity ≥20/80 with a cause of poor vision being cataract, secondary glaucoma, macular pucker, and corneal edema. CONCLUSION Twenty-five-gauge pars plana vitrectomy can achieve excellent attachment rates in eyes with giant retinal tear-associated retinal detachment. It can be as efficient as larger-gauge vitrectomy, at the same time retaining all advantages of smaller-gauge surgery.
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McElnea E, Stephenson K, Gilmore S, O'Keefe M, Keegan D. Paediatric retinal detachment: aetiology, characteristics and outcomes. Int J Ophthalmol 2018; 11:262-266. [PMID: 29487817 DOI: 10.18240/ijo.2018.02.14] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 12/13/2017] [Indexed: 02/02/2023] Open
Abstract
AIM To provide contemporary data on the aetiology, clinical features and outcomes of paediatric retinal detachment. METHODS A retrospective review of all those under 16y who underwent surgical repair for retinal detachment at a single centre between the years 2008 and 2015 inclusive was performed. In each case the cause of retinal detachment, the type of detachment, the presence or absence of macular involvement, the number and form of reparative surgeries undertaken, and the surgical outcome achieved was recorded. RESULTS Twenty-eight eyes of 24 patients, 15 (62.5%) of whom were male and 9 (37.5%) of whom were female, their mean age being 11.6y and range 2-16y developed retinal detachment over the eight year period studied. Trauma featured in the development of retinal detachment in 14 (50.0%) cases. Retinal detachment was associated with other ocular and/or systemic conditions in 11 (39.3%) cases. A mean of 3.0 procedures with a range of 1-9 procedures per patient were undertaken in the management of retinal detachment. Complex vitrectomy combined with scleral buckling or complex vitrectomy alone were those most frequently performed. Mean postoperative visual acuity was 1.2 logMAR with range 0.0-3.0 logMAR. In 22 of 26 (84.6%) cases which underwent surgical repair the retina was attached at last follow-up. CONCLUSION Aggressive management of paediatric retinal detachment including re-operation increases the likelihood of anatomical success. In cases where the retinal detachment can be repaired by an external approach alone there is a more favourable visual outcome.
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Affiliation(s)
- Elizabeth McElnea
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Kirk Stephenson
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Sarah Gilmore
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Michael O'Keefe
- Department of Ophthalmology, Temple Street Children's University Hospital, Dublin 1, Ireland
| | - David Keegan
- Department of Ophthalmology, Mater Misericordiae University Hospital, Dublin 7, Ireland.,Department of Ophthalmology, Temple Street Children's University Hospital, Dublin 1, Ireland
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Nuzzi R, Lavia C, Spinetta R. Paediatric retinal detachment: a review. Int J Ophthalmol 2017; 10:1592-1603. [PMID: 29062781 DOI: 10.18240/ijo.2017.10.18] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 06/23/2017] [Indexed: 11/23/2022] Open
Abstract
Paediatric retinal detachment (PRD) is an uncommon and challenging disease; it differs from adult detachments in etiology, anatomical characteristics, management and prognosis. PRDs can be particularly challenging, even for the most expert paediatric surgeons due to the higher prevalence of total retinal detachments, late diagnosis and bilateral involvement with respect to those which occur in adulthood. Moreover, the anatomical success, when achieved, is frequently not related to a functional recover. Postsurgical adverse events, refractive errors and amblyopia may additionally undermine the final outcome. Up to date there are few reviews regarding the approach of retinal detachment in children, mainly dealing with rhegmatogenous retinal detachment. In this review, rhegmatogenous, retinopathy of prematurity-related and Coats'-related PRDs were considered. The available literature from the last decades were reviewed and summarized. Epidemiology, etiology and clinical presentation, together with therapeutic approaches and outcomes have been reviewed and discussed.
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Affiliation(s)
- Raffaele Nuzzi
- Eye Clinic, Department of Surgical Sciences, University of Turin, Via Juvarra 19, Turin 10122, Italy
| | - Carlo Lavia
- Eye Clinic, Department of Surgical Sciences, University of Turin, Via Juvarra 19, Turin 10122, Italy
| | - Roberta Spinetta
- Eye Clinic, Department of Surgical Sciences, University of Turin, Via Juvarra 19, Turin 10122, Italy
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14
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Zhou DD, Niu K, Lu CW, Hao JL, Zhang BJ, Hui P. Missed Diagnosis of an Intraorbital Foreign Body of Homemade Fireworks Origin: A Case Report. Case Rep Ophthalmol 2016; 6:448-52. [PMID: 26955347 PMCID: PMC4777942 DOI: 10.1159/000442584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose We report a rare case of traumatic injury to the eye caused by homemade fireworks in a Chinese juvenile patient with a metal ring left in the orbit after having been sutured at the Emergency Department. Methods An 11-year-old boy presented with a traumatic injury to the right eye from homemade fireworks. Following initial assessment involving maxillofacial computed tomography (CT) and suturing at the Emergency Department, he was transferred to our department for further evaluation because of his poor sight 1 day later. On examination, a skin laceration beneath the right eyebrow was noted, but the superior orbit was not fully visible on the maxillofacial CT performed 1 day previously. Therefore, an orbital CT scan was carried out on the second day, which showed a hyperdense ring embedded in the superior border of the orbital wall; the ring was surgically removed. On postoperative day 7, a fundus examination revealed resolving vitreous hemorrhage, blunt traumatic retinal detachment, and a large retinal tear superior to the macula. The patient refused to take surgery for retinal detachment into consideration. Therefore, we opted for oral steroids and careful observation. Results After 2 months’ observation, the large retinal tear had healed and white fibrous scar tissue had developed, and the retinal detachment superior to the macula had reattached itself spontaneously. The patient's vision had further improved to 20/200. During 1 year of follow-up, he remained clinically stable. Conclusion To avoid missing the diagnosis, a complete history of the mechanism of injury and accurate imaging still prove most useful. Complete removal of the foreign body by the emergency physician is necessary because of the ocular toxicity of an iron-containing foreign body. As evidenced by the current case, oral steroids and observation for a period of several months is a management of choice for traumatic retinal detachment and retinal tear superior to the macula associated with homemade fireworks in children.
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Affiliation(s)
- Dan-Dan Zhou
- Departments of Radiology, the First Hospital of Jilin University, Changchun, China
| | - Kai Niu
- Departments of Otorhinolaryngology, the First Hospital of Jilin University, Changchun, China
| | - Cheng-Wei Lu
- Departments of Ophthalmology, the First Hospital of Jilin University, Changchun, China
| | - Ji-Long Hao
- Departments of Ophthalmology, the First Hospital of Jilin University, Changchun, China
| | - Bing-Jie Zhang
- Departments of Ophthalmology, the First Hospital of Jilin University, Changchun, China
| | - Peng Hui
- Departments of Ophthalmology, the First Hospital of Jilin University, Changchun, China
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Abstract
PURPOSE To report the management of complicated advanced familial exudative vitreoretinopathy in a predominantly young population. METHODS This retrospective study was performed on 34 eyes of 25 patients with severe complications of advanced familial exudative vitreoretinopathy, including retinal detachment, corneal opacity, shallow or flat anterior chamber, cataract, posterior pupillary adhesion, secondary glaucoma, vitreous hemorrhage, and preretinal hemorrhage. Preoperative and postoperative clinical information was reviewed. RESULTS The average age of the patients was 3.52 ± 5.94 years. Of the 34 eyes, 22 underwent lensectomy, 9 underwent lensectomy combined with vitrectomy, 2 underwent staged lensectomy and vitrectomy, and 1 underwent lens-sparing vitrectomy. After surgery, the shallow or flat anterior chamber became normal in 26/28 eyes; corneal opacity disappeared or improved in 10/22 eyes; and secondary glaucoma was controlled in 22/24 eyes. Among the 12 eyes operated by vitrectomy, the retina was attached in 5 eyes and partly attached in 7. Final visual acuity ranged from no light perception to 30/200 (n = 17). All 5 eyes with preoperative and postoperative visual acuity records showed improvement. CONCLUSION Surgical intervention is recommended to resolve complications of advanced familial exudative vitreoretinopathy and to preserve visual function. Staged lensectomy and vitrectomy is an alternative for advanced familial exudative vitreoretinopathy with corneal complications and/or vascularly active fibrovascular proliferation.
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Hu Y, Tang S. Major challenges in vitreoretinal surgery. Taiwan J Ophthalmol 2014; 5:9-14. [PMID: 29018657 PMCID: PMC5602725 DOI: 10.1016/j.tjo.2014.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/23/2014] [Accepted: 04/25/2014] [Indexed: 11/25/2022] Open
Abstract
Since the first vitrectomy surgery was used for treatment of vitreoretinal diseases, surgical techniques and instrumentation have been rapidly improved in the past decades. However, there are complicated vitreoretinal diseases that cannot be successfully treated, even with state-of-the-art surgeries. The outcomes of some complicated cases are still poor due to different reasons and debates still remain in some areas regarding what are the best treatments. There is still a lack of full understanding on many complicated vitreoretinal diseases, such as the molecular basis of proliferative vitreoretinopathy (PVR), the role of scleral buckling (SB) in the management of rhegmatogenous retinal detachment (RRD), the optimal surgical consideration for pediatric RD, and the possibility of surgical management for various retinal degenerations and congenital retinal anomalies. This review discusses the current understandings of some complicated vitreoretinal diseases.
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Affiliation(s)
- Yijun Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shibo Tang
- Aier School of Ophthalmology, Central South University, Changsha, China
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Choi SW, Kim KS, Kim YC. Clinical Characteristics of Rhegmatogenous Retinal Detachment in Patients under 40 Years of Age. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2014. [DOI: 10.3341/jkos.2014.55.12.1808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sung Won Choi
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Kwang Soo Kim
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yu Cheol Kim
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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Al-Zaaidi S, Al-Rashaed S, Al-Harthi E, Al-Kahtani E, Abu El-Asrar AM. Rhegmatogenous retinal detachment in children 16 years of age or younger. Clin Ophthalmol 2013; 7:1001-14. [PMID: 23818752 PMCID: PMC3693844 DOI: 10.2147/opth.s40056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To study the anatomical and visual outcomes and prognostic factors that may predict the outcomes of rhegmatogenous retinal detachment (RRD) in children. METHODS A retrospective chart review was performed for patients 16 years of age or younger who underwent retinal reattachment surgery for RRD at the King Abdulaziz University Hospital from 1996 to 2005 and the King Khalid Eye Specialist Hospital from 2002 to 2006, Riyadh, Saudi Arabia. Good visual outcome was defined as ≥20/200. The association between two categorical variables was evaluated with the Chi-squared test or the exact test, as appropriate. Predictors for RRD and good final visual acuity were identified by conducting stepwise logistic regression analysis. P < 0.05 was statistically significant. RESULTS The study population comprised 148 patients (166 eyes). There were 104 (70%) males and 44 (30%) females. Mean age at presentation was 8.33 ± 3.26 years (range 1.5-16 years). The retina was reattached after one surgical procedure in 106 (63.8%) eyes and reattached in 130 (78.3%) eyes after multiple surgeries. Factors predicting recurrence after the first surgery were myopia (P = 0.028), proliferative vitreoretinopathy (PVR) at presentation (P = 0.024), and total retinal detachment (P = 0.032). Good final visual outcome was achieved in 60 (44.4%) eyes. Predictors of good visual acuity were: good visual acuity at presentation (P < 0.001); absence of PVR at presentation (P < 0.001); one quadrant of retinal detachment (P = 0.0024); macula on (P = 0.0107); absence of primary repair of a ruptured globe (P = 0.0059); no pars plana vitrectomy (PPV) (P = 0.0123); clear phakic lens at follow-up (P < 0.001); absence of postoperative complications (P < 0.001); absence of recurrence of RRD (P < 0.001); and absence of epiretinal membrane (P = 0.0088). Logistic regression analysis indicated that recurrence of RRD was associated with myopia and previous congenital cataract surgery; good final visual outcome was associated with macula on detachment and poor visual outcome was associated with recurrence of RRD and occurrence of postoperative complications and previous repair of a ruptured globe. CONCLUSION RRD in children is usually associated with a predisposing factor, a high rate of PVR, and total retinal detachment. Despite late diagnosis and the presence of PVR, favorable anatomical and visual outcomes can be achieved.
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Oono Y, Uehara K, Haruta M, Yamakawa R. Characteristics and surgical outcomes of pediatric rhegmatogenous retinal detachment. Clin Ophthalmol 2012; 6:939-43. [PMID: 22791976 PMCID: PMC3392924 DOI: 10.2147/opth.s31765] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the characteristics and surgical outcomes of pediatric rhegmatogenous retinal detachment. Methods A retrospective study of pediatric patients (15 years old or younger) who had undergone primary surgery for rhegmatogenous retinal detachment was conducted. Patients were divided into five groups according to the predisposing factors: trauma (group 1), myopia (group 2), atopic dermatitis (group 3), congenital or developmental anomalies (group 4), and others (group 5). Results A total of 48 eyes of 44 patients were included in this study. There were 18 eyes (37.5%) in group 1, twelve eyes (25.0%) in group 2, six eyes (12.5%) in group 3, five eyes (10.4%) in group 4, and seven eyes (14.6%) in group 5. The initial retinal reattachment rate was 89% in group 1, 100% in group 2, 83% in group 3, 20% in group 4, and 86% in group 5 (P = 0.002). The final retinal reattachment rate was 100% in group 1, 100% in group 2, 100% in group 3, 80% in group 4, and 86% in group 5 (P = 0.16). The frequency of visual acuity of 0.1 or better after surgery was 100% in group 1, 92% in group 2, 83% in group 3, 40% in group 4, and 71% in group 5 (P = 0.01). Conclusion The overall surgical outcome was successful, but the patients in group 4 had the lowest initial reattachment rate and the worst visual prognosis.
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Affiliation(s)
- Yoshihiko Oono
- Department of Ophthalmology, Kurume University School of Medicine, Kurume, Japan
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20
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Wenick AS, Barañano DE. Evaluation and management of pediatric rhegmatogenous retinal detachment. Saudi J Ophthalmol 2012; 26:255-63. [PMID: 23961003 DOI: 10.1016/j.sjopt.2012.04.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 04/28/2012] [Indexed: 11/28/2022] Open
Abstract
Pediatric rhegmatogenous retinal detachments are rare, accounting for less than ten percent of all rhegmatogenous retinal detachments. While most retinal detachments in the adult population are related to posterior vitreous detachment, pediatric retinal detachment are often related to trauma or an underlying congenital abnormalities or genetic syndrome. The anatomy of pediatric eyes, the often late presentation of the disease, and the high incidence of bilateral pathology in children all pose significant challenges in the management of these patients. We discuss the epidemiology of pediatric rhegmatogenous retinal detachment, review the genetic syndromes associated with a high incidence of retinal detachment, and examine other common causes of retinal detachment in this age group. We then outline an approach to evaluation and management and describe the expected outcomes of repair of retinal detachment in the pediatric population.
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Affiliation(s)
- Adam S Wenick
- Department of Ophthalmology, Wilmer Eye Institute, John Hopkins University, Baltimore, MD, United States
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21
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CLINICAL CHARACTERISTICS AND SURGICAL MANAGEMENT OF FAMILIAL EXUDATIVE VITREORETINOPATHY–ASSOCIATED RHEGMATOGENOUS RETINAL DETACHMENT. Retina 2012; 32:220-5. [DOI: 10.1097/iae.0b013e31821c3ec5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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23
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Bier C, Kampik A, Gandorfer A, Ehrt O, Rudolph G. [Retinal detachment in pediatrics : Etiology and risk factors]. Ophthalmologe 2010; 107:165-74. [PMID: 19609777 DOI: 10.1007/s00347-009-1996-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Juvenile retinal detachment is uncommon but is a severe threat to visual acuity. This study demonstrates the etiology and risk factors of retinal detachment in patients age 0-20 years. PATIENTS AND METHODS A cohort was selected comprising 259 patients (278 eyes) who were not older than 20 years at the age at onset of retinal detachment in the only or the first affected eye and had undergone surgery at least once at the Department of Ophthalmology of the University Medical Center of Munich between January 1980 and October 1998. This cohort was analyzed retrospectively with regard to medical antecedents. We separated the group consisting of only one affected eye or the first affected eye (259 eyes) from the group with bilateral retinal detachment (56 eyes). RESULTS Of the 259 patients, 72% were male. The average age of onset was 13.5 years, and 27.8% suffered from a systemic disease in which malformations were frequent. The most frequent ocular antecedents were ocular trauma in 52.9% and ocular malformations, especially myopia in 37.5%. In 58.7% of the fellow eyes, there was a disorder predisposing to retinal detachment, and10.8% of the patients suffered from bilateral retinal detachment. The group with bilateral retinal detachment had a remarkably high percentage of systemic diseases as well as malformations that were most frequent in systemic and ocular antecedents. CONCLUSIONS The study confirms ocular trauma and myopia as important risk factors for juvenile retinal detachment. Because of the high association with malformations as an endogenous background and their conspicuous frequency in patients with bilateral retinal detachment, a genetic background for retinal detachment may be concluded.
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Affiliation(s)
- C Bier
- Augenklinik, Ludwig-Maximilians-Universität München, Mathildenstrasse 8, 80336, München, Deutschland.
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Cheema RA, Al-Khars W, Al-Askar E, Amin YM. Pediatric retinal detachment in the Eastern Province of Saudi Arabia: experience of a tertiary care hospital. Ann Saudi Med 2009; 29:361-4. [PMID: 19700893 PMCID: PMC2860400 DOI: 10.4103/0256-4947.55165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Because no previous studies have addressed the issue, we describe clinical characteristics and surgical outcome of patients with rhegmatogenous retinal detachment (RRD) in a pediatric population of the Eastern province of Saudi Arabia. PATIENTS AND METHODS We conducted a retrospective review of all consecutive cases of pediatric RRD (0-18 years) patients presenting at Dhahran Eye Specialist Hospital, a tertiary care hospital, in the Eastern Province of Saudi Arabia over a period of 3 years. RESULTS Twenty patients were included in the study, accounting for 9.4% of all retinal detachment surgery cases performed over a period of 3 years (January 2006 to December 2008). The median age was 11.0 years, (range, birth to 18 years). Trauma, (45%) myopia/vitreoretinal degeneration (10%) and prior ocular surgery (25%) were significant risk factors for RRD. Proliferative vitreoretinopathy (PVR) more than grade C was present in 14/20 (70%) of cases. Most patients (15/20, 75%) were treated with pars plana vitrectomy and placement of an encircling buckle, while silicone oil or gas was used as tamponade in 13/20 (65%) patients. Surgery was successful in 17/20 (85%) cases in achieving retinal re-attachment. Visual acuity improved significantly following surgery (Mean preop 2.146 LogMAR, Mean postop 1.497 LogMAR) ( P= .014). Longer duration of RRD ( P =.007) and macular involvement ( P =.05) were associated with worse anatomical outcomes following surgery. CONCLUSION Pediatric RRD in the Eastern province is often associated with predisposing pathology. Surgery is successful in achieving anatomical reattachment of the retina in a majority of cases with improvement of visual acuity.
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Wang NK, Chen TL, Lai CC, Kuo YH, Chao AN, Wu WC, Chen KJ, Hwang YS, Chen YP, Liu L. Clinical characteristics and surgical outcomes of pediatric retinal detachments with lens disorders. J Pediatr Ophthalmol Strabismus 2009; 46:160-7. [PMID: 19496497 DOI: 10.3928/01913913-20090505-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the clinical characteristics and outcomes of eyes with retinal detachments with lens disorders and compare them to eyes with retinal detachments without lens disorders. METHODS A retrospective chart review of 42 eyes of 37 children who had retinal detachments with lens disorders was performed. Eyes were compared based on epidemiological data, characteristics of retinal detachment, and anatomical and functional surgical outcomes and were then compared to 254 eyes with retinal detachment without lens disorders. RESULTS In eyes with lens disorders, the retina was reattached after the first operation in 13 (31%) eyes and at the end of the intervention in 22 (52%) eyes. Surgical and visual outcomes appeared to be slightly better in the subluxation and dislocation group compared with cataract and aphakia or pseudophakia groups. In eyes without lens disorders, the retina was reattached in 202 (80%) eyes after the first intervention and in 228 (90%) eyes at the end of the intervention. CONCLUSION Pediatric retinal detachment with a lens disorder is associated with unsatisfactory surgical and visual outcomes compared to those without lens disorders. Primary internal and external approaches are suggested in children with complicated retinal detachment with lens disorders.
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Affiliation(s)
- Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkuo, Taoyuan, Taiwan
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Wadhwa N, Venkatesh P, Sampangi R, Garg S. Rhegmatogenous retinal detachments in children in India: clinical characteristics, risk factors, and surgical outcomes. J AAPOS 2008; 12:551-4. [PMID: 18835797 DOI: 10.1016/j.jaapos.2008.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 04/27/2008] [Accepted: 05/04/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To describe the spectrum of clinical features and surgical outcomes in children with rhegmatogenous retinal detachments in a tertiary-care hospital in northern India. METHODS In this retrospective interventional case series, 230 eyes of 216 children 18 years of age or younger undergoing surgery for rhegmatogenous retinal detachment were included. Detailed history and complete ophthalmic and systemic examination was performed when essential. Risk factors for retinal detachment were noted. Surgical intervention consisted of scleral buckling alone or standard 3-port pars plana vitrectomy with silicone oil tamponade. Rate of anatomical attachment and status of postoperative visual acuity were noted. RESULTS Mean age was 11.12 +/- 3.56 years. Most patients (81.9%) were boys. Thirty-five (16.2%) patients had bilateral retinal detachment at presentation. Detachments tended to be complex, with 54.3% (125/230 eyes) having some form of proliferative vitreoretinopathy. Mean follow-up was 12.3 months. Complete retinal reattachment was achieved in 88.7% of eyes; however, visual recovery was modest. CONCLUSIONS The most common conditions predisposing to rhegmatogenous retinal detachment were peripheral retinal degeneration and trauma. Rhegmatogenous retinal detachments secondary to iridofundal coloboma may be more common than previously reported. A combination of buckling and vitreoretinal techniques helped achieve retinal reattachment in most cases. The presence of anterior proliferative vitreoretinopathy is a poor prognostic factor in terms of both anatomic success as well as visual improvement.
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Affiliation(s)
- Neeraj Wadhwa
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Abstract
PURPOSE To report a series of macular sparing rhegmatogenous retinal detachment (MSRRD) in teenagers treated with demarcation laser photocoagulation. METHODS Retrospective, interventional, and noncomparative case series of 36 eyes in 33 patients with primary MSRRD. Eyes with ocular congenital anomalies or perforation ocular injury were excluded from this study. All eyes received three or more rows of confluent demarcation laser photocoagulation at the margin of retinal detachment. Best corrected preoperative and postoperative visual acuity and progression of retinal detachment during the follow-up were recorded. RESULTS Thirty two eyes needed only one session of laser to wall off the retinal detachment. The other four eyes required one additional laser because of progressive retinal detachment. All but one eye had shallow retinal detachment and retinal detachment was successfully demarcated after 1 or 2 episodes of laser treatment at the final visit. Patients were observed up at our clinic from 1 to 6 years. Myopia greater than -3 D was noted in all but one eye. Atrophic holes with or without lattice were the causative breaks in all eyes. All patients maintained best corrected visual acuity equal or better than 20/30. CONCLUSION Demarcation laser could successfully wall off macular sparing retinal detachment in teenagers.
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Pediatric rhegmatogenous retinal detachment: clinical features and surgical outcomes. Retina 2008; 28:847-52. [PMID: 18536601 DOI: 10.1097/iae.0b013e3181679f79] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Gekeler F, Szurman P, Grisanti S, Weiler U, Claus R, Greiner TO, Völker M, Kohler K, Zrenner E, Bartz-Schmidt KU. Compound subretinal prostheses with extra-ocular parts designed for human trials: successful long-term implantation in pigs. Graefes Arch Clin Exp Ophthalmol 2007; 245:230-41. [PMID: 16645861 DOI: 10.1007/s00417-006-0339-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Revised: 03/13/2006] [Accepted: 03/24/2006] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Subretinal implants aim to replace photoreceptor function in patients suffering from degenerative retinal disease like retinitis pigmentosa by topically applying electrical stimuli in the subretinal space. This study-as a last step before upcoming human trials-explored a newly developed surgical technique for permanent implantation of complex subretinal implants with extra-ocular parts. METHODS The implant consisted of a microphoto-diode array (MPDA) with 1550 electrodes and a 4x4 array of gold electrodes for direct electrical stimulation; both were mounted onto a polyimide foil for transscleral placement into the subretinal space. The foil carried connection lanes to a silicone cable that was implanted under the skin and led to a stimulator box in the animal's neck. Surgery was performed in 11 domestic pigs. Improved vitreo-retinal surgical technique consisted of a 180 degrees peripheral retinotomy and use of diathermy to penetrate the choroid in order to avoid choroidal haemorrhage. Subretinal forceps were used to place the implant safely onto the retinal pigment epithelium before the retina was flattened, peripheral laser photocoagulation was applied and the eye was filled with silicon oil. The implant was stabilized by a scleral fixation patch, use of a metal clamp with bone screws on the animal's skull and a tissue ring under the animal's skin in the neck. Behaviour was observed in the freely moving animals after direct subretinal electrical stimulation and funduscopy, optical coherence tomography, fluorescein angiography and histology were performed. RESULTS All implants were successfully placed subretinally. In three animals a proliferative vitreo-retinopathy was observed after approximately 2 weeks. Otherwise, funduscopy and OCT demonstrated complete retinal attachment and FA showed no retinal vascular abnormalities over and around the implant. The animals showed clear behavioural reactions to electrical stimulation over the whole examination period. Histological examination failed to show any voltage-induced alteration in the cellular architecture of the retina overlying the stimulation electrodes. CONCLUSIONS This study demonstrates the feasibility of a new surgical procedure for highly safe and controlled implantation of complex subretinal devices with extra-ocular parts. The new implant design proved to be safely implantable in free-moving pigs for an observation period of 4 weeks.
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Affiliation(s)
- Florian Gekeler
- Centre for Ophthalmology, Schleichstrasse 12-16, 72076 Tübingen, Germany.
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Wang NK, Chen YP, Yeung L, Chen KJ, Chao AN, Kuo YH, Lee JS, Lai CC. Traumatic pediatric retinal detachment following open globe injury. Ophthalmologica 2007; 221:255-63. [PMID: 17579292 DOI: 10.1159/000101928] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Accepted: 09/20/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE It was the aim of this study to describe the clinical features and surgical outcomes of retinal detachment following open globe injuries in a pediatric population. METHODS The study was a retrospective chart review of 33 children who had undergone surgery for retinal detachment after open globe injury. RESULTS The mean age was 11 years (range 4-18) and the mean follow-up period was 57.1 months (range 6-204). Twenty-five patients (76%) were males. Of the open globe injuries, 21 (64%) were penetrations, 6 (18%) intraocular foreign bodies, and 6 (18%) ruptures. Eighteen retinal detachments (55%) were identified by B-scan. Eighteen eyes (55%) had total retinal detachment and 23 eyes (70%) showed macular involvement. Twenty-one eyes (64%) presented with proliferative vitreoretinopathy (PVR) grade C or worse. Retinal reattachment was successful in 12 eyes (36%). Best-corrected visual acuity of 20/100 or better was noted in 4 eyes (12%) preoperatively and in 12 eyes (35%) postoperatively. Features seen in patients with a poor surgical outcome included undetermined or light perception only preoperative vision (p = 0.012), diagnosis by B-scan (p = 0.003), the presence of PVR grade C or worse (p = 0.001), total retinal detachment (p = 0.001), and macula-off status (p = 0.016). CONCLUSIONS Our findings suggest that retinal detachment caused by open globe injuries in the pediatric population is associated with worse surgical results and unsatisfied visual outcomes. Early vitrectomy, before a diagnosis of retinal detachment is made by serial echographic examinations, may be considered to reduce the incidence of PVR. Further clinical research is required to identify ways to improve the outcomes for these patients.
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Affiliation(s)
- Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkuo Medical Center, No. 5 Fu-Hsing Street, Kuei Shan, Taoyuan 333, Taiwan, ROC
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Chen SN, Hwang JF. Treatment of rhegmatogenous retinal detachment in teenagers by pneumatic retinopexy technique. Am J Ophthalmol 2007; 143:217-221. [PMID: 17184718 DOI: 10.1016/j.ajo.2006.10.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Revised: 10/18/2006] [Accepted: 09/12/2006] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the effectiveness of pneumatic retinopexy as an alternative technique for rhegmatogenous retinal detachment (RD) repair in teenagers. DESIGN Retrospective, noncomparative, interventional case series. METHODS We conducted a review of 19 patients (19 eyes) younger than 20 years of age who had undergone pneumatic retinopexy as the initial procedure for rhegmatogenous RD between 1995 and 2002. RESULTS Fourteen boys and five girls (mean age of 17.1 years) were included in this study. Two eyes had a history of trauma. Seventeen eyes (89.5%) had myopia of > -3 diopters. The averaged refraction of the operated eyes was -6.11 diopters (range, -1.25 to -9.5 diopters). Macular detachment was found in 13 eyes (68.4%). Subretinal fibrosis was present in six eyes (31.6%). Pneumatic retinopexy resulted in reattachment in 16 eyes (84.2%) with one injection of gas. One patient required a second injection of gas. Two patients needed additional scleral buckling to attach the retina. Displaced subretinal fluid and delayed resorption of subretinal fluid were noted in four eyes. Mean follow-up period was 42.7 months (range, six to 75 months). CONCLUSIONS Rhegmatogenous RD in teenagers can be treated with pneumatic retinopexy with an overall successful rate as in adults. More attention is required regarding the postoperative stage and follow-up period to ensure surgical success.
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Affiliation(s)
- San-Ni Chen
- Department of Ophthalmology, Changhua Christian Hospital, Taiwan, ROC
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Rumelt S, Sarrazin L, Averbukh E, Halpert M, Hemo I. Paediatric vs adult retinal detachment. Eye (Lond) 2006; 21:1473-8. [PMID: 16878114 DOI: 10.1038/sj.eye.6702511] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To evaluate the causes, incidences, characteristics, and treatment outcomes of paediatric vs adult retinal detachment. PATIENTS AND METHODS One hundred and sixty (136 patients) out of 2408 consecutive retinal detachments (6.6%) at our facility occurred in children under the age of 18 years. Of them, 144 eyes (90%) of 127 (93%) children were treated and compared with a sample of 56 consecutive retinal detachments in 50 adults (over the age of 18 years). The parameters for comparison included cause, type of retinal detachment, its extent, macular involvement, number of tears, number and types of surgery, and the anatomic and functional surgical outcome. RESULTS Statistically significant differences were found in the type of retinal detachment. Rhegmatogenous RD was less common (P=0.004), and exudative RD was more common (P=0.021) in the paediatric group. Ocular trauma and ocular syndromes were more common in the paediatric group (P<0.001), while myopia, posterior vitreous detachment, and retinal detachment following cataract surgery were less common in this group compared with adults (P<0.001, <0.001, and 0.001, respectively). Ocular pathologies associated with retinal detachment were more common in the paediatric group (P<0.001). Initial and last visual acuity of >20/400, last visual acuity of >20/40, and retinal complete reattachment were higher in adults (P<0.001). CONCLUSIONS The type of retinal detachment, causes and outcomes were statistically different between paediatric and adult cases. The less successful functional and anatomical outcomes of retinal detachment surgery in children may reflect the different aetiologies and indicate the need for aetiology-specific treatment strategies according to each aetiology.
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Affiliation(s)
- S Rumelt
- Department of Ophthalmology, Western Galilee - Nahariya Medical Center, Nahariya, Israel
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Abstract
PURPOSE To describe the clinical features and surgical outcomes in a series of pediatric patients with rhegmatogenous retinal detachments in Taiwan. METHODS Retrospective study of pediatric patients (age 1 to 15 years) with rhegmatogenous retinal detachment dated between January 1995 and December 2004. Patients with perforating ocular trauma were excluded. Patients were divided into four groups according to the predisposing factors: Group 1, those with congenital or developmental anomalies; Group 2, those with trauma history; Group 3, those with myopia greater than -3 D but excluding patients in Groups 1 and 2; and Group 4, the others with miscellaneous etiologies. Patients' age, sex, medical history, ocular history, type of detachment, macular status, refractive status, previous visual acuity, number and type of surgeries performed, postoperative retinal status, and current visual acuity were recorded. RESULTS Thirty-five eyes of 32 patients were included in this study. The median age was 13 years, and 75% of patients were boys. There were 17 eyes (49%) in Group 1, 8 in Group 2 (23%), 8 in Group 3 (23%), and 2 in Group 4 (6%). Bilateral retinal detachment was present in 7 patients (22%). In Group 1, familial exudative vitreoretinopathy was present in 7 eyes; retinopathy of prematurity was noted in 5 eyes; Marfan's syndrome was present in 3 eyes; mental and growth retardation was present in 2 eyes. Macula sparing retinal detachment was found in 3 eyes. Retinal attachment was achieved in 28/35 eyes. Visual recovery was modest. CONCLUSION Congenital or developmental anomalies, myopia, and trauma were the most common risk factors for pediatric rhegmatogenous retinal detachment in Taiwan. Regular follow-up for children at risk of developing rhegmatogenous retinal detachment is necessary for early detection.
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Affiliation(s)
- San-Ni Chen
- Department of Ophthalmology, Changhua Christian Hospital, No. 135 Nan-Hsiao Street, Changhua City, Taiwan, ROC.
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Minamoto A, Yokoyama T. Reply to DTL Liu et al. Eye (Lond) 2006. [DOI: 10.1038/sj.eye.6701823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Meier P, Wiedemann P. Surgical Aspects of Vitreoretinal Disease in Children. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wang NK, Tsai CH, Chen YP, Yeung L, Wu WC, Chen TL, Lin KK, Lai CC. Pediatric rhegmatogenous retinal detachment in East Asians. Ophthalmology 2005; 112:1890-5. [PMID: 16271317 DOI: 10.1016/j.ophtha.2005.06.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Accepted: 06/16/2005] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To describe clinical features, predisposing factors, and surgical outcomes of retinal detachment in different age groups in a pediatric population. DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS A total of 296 eyes from 278 children younger than 18 years of age underwent the first surgical procedure for rhegmatogenous retinal detachment between 1983 and 2003. They were divided into 3 age groups: 38 eyes in group 1 (0-10 years), 107 eyes in group 2 (11-15 years), and 151 eyes in group 3 (16-18 years). METHODS Predisposing factors for retinal detachment were classified into 4 categories: (1) high myopia, (2) trauma, (3) congenital or developmental structural ocular abnormalities, and (4) previous intraocular surgery. MAIN OUTCOME MEASUREMENTS Visual acuity and retinal reattachment. RESULTS The mean age of the patients was 14.6 years; 73.7% were boys. The mean follow-up period was 51 months. At least 1 predisposing factor could be identified in 282 (95%) of study eyes. High myopia was most common in 111 eyes (38%). Thirty-one percent of eyes experienced trauma, 17% had structural abnormalities, and 5% underwent previous intraocular surgery. Macular involvement was found in 237 eyes (80%). The initial surgery was scleral buckling alone in 224 eyes (76%). Retinal reattachment was achieved in 214 eyes (72%) after the first operation and in 250 eyes (85%) at the end of intervention. Features seen in patients with a poor surgical outcome included congenital anomaly (P<0.001), previous intraocular surgery (P = 0.007), proliferative vitreoretinopathy grade C or worse (P<0.001), macula off (P = 0.001), total retinal detachment (P<0.001), and use of silicone oil (P<0.001). CONCLUSIONS Myopia is one of the important predisposing factors of pediatric retinal detachment in East Asians. The predisposing factors, clinical features, timing of diagnosis, and frequency of proliferative vitreoretinopathy of retinal detachment are somewhat different in the 3 age groups considered. Because of higher proportions of congenital anomaly, total retinal detachment, proliferative vitreoretinopathy, and a low success rate with poor postoperative compliance, patients in group 1 experienced the lowest final reattachment rate and the worst visual recovery.
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Affiliation(s)
- Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Wu WC, Lai CC, See LC, Tsao YP, Yang KJ, Chen TL. Unambiguous Comparison of Juvenile and Senile Rhegmatogenous Retinal Detachment. Ophthalmic Surg Lasers Imaging Retina 2005. [DOI: 10.3928/1542-8877-20050501-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Yokoyama T, Kato T, Minamoto A, Sugihara A, Imada M, Kuwabara R, Mizote H, Yamane K, Jian K, Tamura H, Noma H, Mishima HK. Characteristics and surgical outcomes of paediatric retinal detachment. Eye (Lond) 2004; 18:889-92. [PMID: 14752507 DOI: 10.1038/sj.eye.6701341] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To report the clinical features and surgical and visual outcomes of rhegmatogenous retinal detachment (RRD) in the paediatric population. METHODS A retrospective review of children (aged 0-15 years) who underwent primary surgical repair for RRD at the Hiroshima University Hospital between 1988 and 2001. RESULTS In all 53 eyes of 49 patients were identified; paediatric RRD accounted for 3.1% of 1779 eyes with RRD operated on during this period. The causes of RRD included blunt trauma (27%), myopia (25%), idiopathic (20%), familial exudative vitreoretinopathy (13%), and others. Among 55 eyes, 12 (22%) already had proliferative vitreoretinopathy (PVR) of grade C or D preoperatively. The median initial visual acuity (VA) was 0.3. Retinal reattachment was achieved with a single operation in 78%. Final retinal reattachment was achieved in 87%. Retinal reattachment rates with and without PVR were 42% and 100%, respectively (P<0.01). Median final VA was 0.7. Final VA was > or =0.1 in 73% and > or =0.5 in 53%; four eyes had a final VA of no light perception. The presence of preoperative PVR (P=0.03) and the initial VA (P<0.0001) significantly affected final VA. CONCLUSIONS Paediatric RRD is characterised by a delay in diagnosis, as evidenced by the high rate of PVR at presentation. Retinal reattachment was adversely affected by the presence of PVR. Final VA correlated with the initial VA and was significantly affected by preoperative PVR. Early diagnosis may improve the visual prognosis of paediatric retinal detachment.
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Affiliation(s)
- T Yokoyama
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Japan
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