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. 2019 Sep;126(9):1263-1270.
doi: 10.1016/j.ophtha.2018.11.001. Epub 2018 Nov 10.

Rhegmatogenous Retinal Detachment in Children: Clinical Factors Predictive of Successful Surgical Repair

Jesse M Smith  1 , Laura T Ward  2 , Justin H Townsend  3 , Jiong Yan  4 , Andrew M Hendrick  4 , Blaine E Cribbs  4 , Steven Yeh  4 , Nieraj Jain  4 , G Baker Hubbard 3rd  5
Affiliations

Rhegmatogenous Retinal Detachment in Children: Clinical Factors Predictive of Successful Surgical Repair

Jesse M Smith et al. Ophthalmology. 2019 Sep.

Abstract

Purpose: To describe presenting clinical features and surgical techniques that are associated with successful surgical repair of pediatric rhegmatogenous retinal detachment (RRD).

Design: Retrospective interventional case series.

Participants: Two hundred twelve eyes of 191 patients 0 to 18 years of age undergoing surgical repair for RRD between 2001 and 2015 with a minimum follow-up of 3 months.

Methods: Patients were divided into 3 age groups (0-6 years, 7-12 years, and 13-18 years) and comparisons were made using bivariate and multivariate generalized estimating equation models. A mixed means model was used to examine visual acuity in each age group over time.

Main outcome measures: Complete reattachment of the retina at final follow-up.

Results: Of 212 eyes, 166 (78%) achieved total reattachment at final follow-up. Mean follow-up was 36.3 months. Rhegmatogenous retinal detachment associated with Stickler syndrome was more likely to occur in the younger cohorts (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.22-0.91), whereas RRD associated with blunt trauma was more likely to occur in the oldest cohort (OR, 2.3; 95% CI, 1.2-4.4). Subtotal RRD was more likely to be repaired successfully than total RRD (OR, 3.6; 95% CI, 1.5-8.4; P = 0.0100), and eyes with previous vitreoretinal surgery were less likely to undergo successful repair (OR, 0.30; 95% CI, 0.12-0.78; P = 0.0258). There was no significant difference between age groups in the rate of surgical success (P = 0.55). There was a significantly higher success rate with primary scleral buckle (SB; 63%; OR, 2.2; 95% CI, 1.1-4.5) and combined SB plus pars plana vitrectomy (PPV; 68%; OR, 2.3; 95% CI, 1.1-5.1) compared with PPV alone (51%).

Conclusions: Most pediatric patients with RRD achieved complete reattachment with surgery. Success was more common in patients with a subtotal RRD at presentation. Previous vitreoretinal surgery was a risk factor for failure. Younger patients were more likely to demonstrate RRD involving the macula, but there was no difference between age groups in successful reattachment at final follow-up. Primary PPV showed a lower rate of success than SB or combined SB plus PPV.

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Conflict of interest statement

No conflicting relationship exists for any author.

Figures

Figure 1.
Figure 1.
Adjusted mean logMAR visual acuity and 95% confidence intervals for patients with multiple surgery success divided by age group.
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Comment in

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