We investigated characteristics and treatment outcomes of pediatric vs adult retinal detachment managed by retinotomy and retinectomy.
Methods
This was a retrospective, nonrandomized, interventional study involving 20 pediatric patients and 25 adult patients operated with vitrectomy and retinectomy due to retinal detachment. Outcome measures included preoperative and postoperative visual acuity at 6 months and at final visit, postoperative proliferative vitreoretinopathy silicone oil removal, final intraocular pressure (IOP), and final anatomic success, defined as complete retinal reattachment.
Results
Reattachment was observed in 60% (12/20) of pediatric patients and 88% (22/25) of adults at final visit (p=0.041). Statistically significant improvement in visual acuity was observed in adults (p<0.001) but not in children (p=0.360) due to large proportion of anatomic failure. Children required a higher number of further reoperations (p=0.008). Postoperative proliferative vitreoretinopathy was significantly more frequent in pediatric eyes (p=0.003).
Conclusions
The clinical features and prognosis for pediatric retinotomies and retinectomies are different from those for adults. When a decision to perform retinotomy in children is made, we can anticipate significantly lower anatomic success than in adults. Even though the overall visual acuity was worse in children than in adults, 25% of pediatric eyes achieved 5/50 or better vision.
GonzalesC.R., SinghS., YuF., KreigerA.E., GuptaA., SchwartzS.D.Pediatric rhegmatogenous retinal detachment: clinical features and surgical outcomes. Retina2008; 28: 847–52.
3.
MachemerR.Schneiden der Netzhaut: Eine Behandlungsmöglichkeit zur Wiederanlegung der Netzhaut. Klin Monatsbl Augenheilkd1979; 175: 597–601.
4.
LewisH., AabergT.M., AbramsG.W.Causes of failure after initial vitreoretinal surgery for severe proliferative vitreoretinopathy. Am J Ophthalmol1991; 111: 8–14.
5.
MorseL.S., McCuenBWII, MachemerR.Relaxing retinotomies: analysis of anatomic and visual results. Ophthalmology1990; 97: 642–7, discussion 647–8.
6.
AlturkiW.A., PeymanG.A., ParisC.L., BlinderK.J., DesaiU.R., NelsonNCJJr.Posterior relaxing retinotomies: analysis of anatomic and visual results. Ophthalmic Surg1992; 23: 685–8.
7.
BoveyE.H., De AncosE., GonversM.Retinotomies of 180 degrees or more. Retina1995; 15: 394–8.
8.
TsengJ.J., BarileG.R., SchiffW.M., AkarY., Vidne-HayO., ChangS.Influence of relaxing retinotomy on surgical outcomes in proliferative vitreoretinopathy. Am J Ophthalmol2005; 140: 628–36.
9.
QuiramP.A., GonzalesC.R., HuW.Outcomes of vitrectomy with inferior retinectomy in patients with recurrent rhegmatogenous retinal detachments and proliferative vitreoretinopathy. Ophthalmology2006; 113: 2041–7.
10.
GrigoropoulosV.G., BensonS., BunceC., CharterisD.G.Functional outcome and prognostic factors in 304 eyes managed by retinectomy. Graefes Arch Clin Exp Ophthalmol2007; 245: 641–9.
11.
de SilvaD.J., KwanA., BunceC., BainbridgeJ.Predicting visual outcome following retinectomy for retinal detachment. Br J Ophthalmol2008; 92: 954–8.
12.
TanH.S., MuraM., ObersteinS.Y.L., de SmetM.D.Primary retinectomy in proliferative vitreoretinopathy. Am J Ophthalmol2010; 149: 447–52.
13.
MachemerR., McCuenBWII, de JuanEJr.Relaxing retinotomies and retinectomies. Am J Ophthalmol1986; 102: 7–12.
14.
FedermanJ.L., EagleRCJJr.Extensive peripheral retinectomy combined with posterior 360 degrees retinotomy for retinal reattachment in advanced proliferative vitreoretinopathy cases. Ophthalmology1990; 97: 1305–20.
15.
HanD.P., LewisM.T., KuhnE.M.Relaxing retinotomies and retinectomies: surgical results and predictors of visual outcome. Arch Ophthalmol1990; 108: 694–7.
16.
KolomeyerA.M., GrigorianR.A., MostafaviD., BhagatN., ZarbinM.A.360° retinectomy for the treatment of complex retinal detachment. Retina2011; 31: 266–74.
17.
KonoT., OshimaK., FuchinoY.Surgical results and visual outcomes of vitreous surgery for advanced stages of retinopathy of prematurity. Jpn J Ophthalmol2000; 44: 661–7.
18.
TothC.A., FreedmanS.F.Macular translocation with 360-degree peripheral retinectomy impact of technique and surgical experience on visual outcomes. Retina2001; 21: 293–303.
19.
GibranS.K., RomanoM.R., WongD.Perfluorocarbon liquid assisted large retinal epithelium patching in sub-macular hemorrhage secondary to age related macular degeneration. Graefes Arch Clin Exp Ophthalmol2009; 247: 187–91.
20.
CeredaM.G., ParoliniB., BellesiniE., PertileG.Surgery for CNV and autologous choroidal RPE patch transplantation: exposing the submacular space. Graefes Arch Clin Exp Ophthalmol2010; 248: 37–47.
21.
García-ArumíJ., SararolsL., MartinezV., CorcosteguiB.Vitreoretinal surgery and endoresection in high posterior choroidal melanomas. Retina2001; 21: 445–52.
22.
IversonD.A., WardT.G., BlumenkranzM.S.Indications and results of relaxing retinotomy. Ophthalmology1990; 97: 1298–304.
23.
BourkeR.D., DowlerJ.G., MillikenA.B., CoolingR.J.Perimetric and angiographic effects of retinotomy. Aust NZ J Ophthalmol1996; 24: 245–9.
24.
MachemerR., AabergT.M., FreemanH.M., IrvineA.R., LeanJ.S., MichelsR.M.An updated classification of retinal detachment with proliferative vitreoretinopathy. Am J Ophthalmol1991; 112: 159–65.
25.
R Development Core Team. R: A Language and Environment for Statistical Computing.Vienna: R Foundation for Statistical Computing; 2011.
26.
HanD.P., RychwalskiP.J., MielerW.F., AbramsG.W.Management of complex retinal detachment with combined relaxing retinotomy and intravitreal perfluoro-n-octane injection. Am J Ophthalmol1994; 118: 24–32.
27.
MachemerR.Retinotomy. Am J Ophthalmol1981; 92: 768–74.
