gms | German Medical Science

Background: To show current data on the etiology, 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/patients: Retrospective chart review of 55 eyes (50 patients) with rhegmatogenous retinal detachment (RRD) between 2000 and 2010.

Results:

1.

Only 10 eyes showed RRD without any identifiable risk factor (idiopathic). The remainder 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 disposing factor.

2.

At initial presentation, 16,4% had already 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.

3.

Dependent on the clinical situation, 72% of eyes with RRD/no PVR had buckling surgery and 28% had primarily vitreous surgery. All eyes with PVR underwent vitrectomy/silicone oil tamponade. Primary success rates of the subgroups were 70%, 15.4% and 33%, respectively, final success 100%, 92% and 75%. In 6 eyes with primary or secondary silicone oil tamponade, the tamponade agent stayed in situ.

4.

Significant visual improvement was achieved in eyes with 1° success, function was stabilized on a low level in eyes that were reattached after revision surgeries.

Conclusions: Pediatric RRDs differ from adult RRD in many respects: they show a 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.