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

• Type of Material: Article
• Authors: Jesse Smith, Emory University; Laura Ward, Emory University; Justin H. Townsend, University of Miami; Jiong Yan, Emory University; Andrew Hendrick, Emory University; Blaine Cribbs, Emory University; Steven Yeh, Emory University; Nieraj Jain, Emory University; George Hubbard, Emory University
• Language: English
• Date: 2019-09-01
• Publisher: Elsevier Science Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 by the American Academy of Ophthalmology.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ophtha.2018.11.001
• Title of Journal or Parent Work: Ophthalmology
• Volume: 126
• Issue: 9
• Start Page: 1263
• End Page: 1270
• Grant/Funding Information: National Eye Institute Core Grant P30 EY006360
• Keywords: Features; Risk-factors; Ophthalmology; Outcomes; Life Sciences & Biomedicine; Science & Technology
• Research Categories: Health Sciences, Opthamology; Biology, Bioinformatics; Biology, Biostatistics

Abstract

Objective: 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. Subjects: 212 eyes of 191 patients, aged 0–18 years, undergoing surgical repair for RRD between 2001 and 2015 with a minimum follow up of 3 months. Methods: Patients were divided into three age groups (0–6 years, 7–12 years, 13–18 years) and comparisons were made using bivariate and multivariable 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 a total of 212 eyes, 166 (78%) achieved total reattachment at final follow up. Mean follow up was 36.3 months. RRD 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), while 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 successfully repaired 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 have 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 scleral buckle/vitrectomy (SB/PPV) (68%, OR 2.3 95% CI 1.1–5.1) compared to vitrectomy (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 present with RRD involving the macula but there was no difference between age groups in successful reattachment at final follow up. Primary PPV had a lower rate of success than SB or combined SB/PPV.