Pediatric Rhegmatogenous Retinal Detachment

Abstract

Rhegmatogenous retinal detachment (RRD) is a major cause of blindness in adults but is uncommon in children, ranging from 3% to 12% of all patients suffering from RRD. 1-6 Although the incidence of RRD in children is quite low, this entity merits scrutiny for at least 2 reasons: the high rate of vision-threatening pathology in the fellow eye and the considerable financial and emotional investment incurred when the decision is made to attempt to repair such eyes.The etiologic factors, clinical features, surgical outcomes, and prognosis of pediatric RRD differ from those of adults and the repair of these cases poses a formidable challenge to the vitreoretinal surgeon. 6-13 Unlike adults with RRD, children more often present with macula-involving RRD, proliferative vitreoretinopathy (PVR), and a longstanding retinal detachment which may be because of late diagnosis and referral. In addition, they often have underlying predisposing conditions with a high frequency of ocular lesions in the fellow eyes. Many of these factors may have an impact on the visual outcome and are important to consider when discussing the prognosis with the patient and/or family.The anatomic success of RRD surgery in pediatric patients is lower than that in adult. 6,[9][10][11][12][13][14] Several large series of RRD in pediatric patients were compiled before the availability of modern vitrectomy techniques. [1][2][3][4][15][16][17][18][19][20] Technical advances and a greater understanding of retinal anatomy and pathology have expanded our repertoire of vitreoretinal www.internat-ophthalmology.com | 147

Evaluation and management of pediatric rhegmatogenous retinal detachment

“…54 The presence of a single family with three affected children with bilateral retinal detachments suggests a strong genetic component in at least some cases. 53 The true prevalence of this condition is not known. It is possible that some cases of retinal detachment caused by retinal dialysis that is attributed to minor trauma reflect a strong genetic predisposition.…”

“…They occur in the general population at a rate of 0.14%. 52,53 Retinal breaks can occur at the borders of the coloboma, and a high rate of retinal detachment has been reported with colobomas of the choroid. In case series of pediatric RRD, choroidal coloboma associated detachments account for up to 2% of the cases of RRD 8,14 and up to 8% in children under age 10.…”

“…PVR is rare in this condition and most patients do well with scleral buckling procedures. 53 Several lines of evidence suggest a strong genetic component to non-traumatic retinal dialysis. In his analysis of 24 sibships with atraumatic retinal dialysis, Verdaguer et al reported eight instances where more than one family member was affected.…”

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

“…1 Unlike their adult counterparts, children with RRD often present as a challenge to the operating surgeon. They usually present late with macula-off RRD and proliferative vitreoretinopathy (PVR).…”

“…They usually present late with macula-off RRD and proliferative vitreoretinopathy (PVR). 1 There are often underlying risk factors such as trauma, congenital-developmental ocular disorders, myopia, or prior surgery that affect visual prognosis. [2][3][4][5][6] Some patients have systemic conditions (eg, Stickler syndrome, Marfan syndrome) that would predispose both eyes to RRD.…”