Pediatric rhegmatogenous retinal detachment

Abstract

Purpose: To review the clinical features and surgical and visual outcomes of pediatric rhegmatogenous retinal detachment (RRD) as seen in a tertiary referral center.

Methods: Retrospective case series spanning 6 years from January 1, 1991 to January 1, 1997. Exclusionary criteria were trauma disrupting the globe and acute retinopathy of prematurity.

Results: The authors reviewed a series of 29 eyes in 27 pediatric patients (birth to 18 years of age) with RRD. Seventy percent of the patients were male. The mean patient age was 9.6 years. Bilateral RRD was present in 22% of patients; 89% of patients had some form of bilateral ocular pathology at initial presentation. The two most common etiologies (34% each) were myopia and eyes that had undergone surgery for another ocular disorder with subsequent development of RRD. The most common presentation was decreased vision, with a mean duration of 52 days. At presentation, 75% of the affected eyes and 48% of the fellow eyes had visual acuity worse than 20/800. The most common type of retinal break was a horseshoe tear. Late diagnosis was a common problem, evidenced by the frequency of macular detachment (79%) and proliferative vitreoretinopathy (45%) at initial presentation. The most common primary repair was a scleral buckle. Anatomic reattachment was ultimately accomplished in 72% of cases with a mean of 2.2 surgeries per eye. Average postoperative follow-up time was 21.4 months (range 4 to 61 months). At final follow-up, 41% of the affected eyes had visual acuity 20/800 or better. Thirty-eight percent of the affected eyes had a final visual acuity better than or equal to the fellow eye.

Conclusion: In this series, pediatric RRD occurred most commonly in association with myopia (Stickler's syndrome and adolescent retinopathy of prematurity) and prior intraocular surgery. Most eyes were anatomically reattached after multiple surgeries. Forty-one percent of eyes retained vision of 20/800 or better. Preserving vision in children with RRD is of great importance, particularly given the 89% frequency of vision-threatening abnormalities in fellow eyes.