Pediatric retinal detachment

PediatricPediatric retinalretinal detachmentdetachment: a : a surveysurvey fromfrom a a pediatricpediatric hospitalhospital

Jaume Jaume CatalàCatalà MoraMora

Jesús Díaz Jesús Díaz CascajosaCascajosa

Joan Prat BartomeuJoan Prat Bartomeu

IntroductionIntroduction

�� LowLow incidenceincidence3/10.000/3/10.000/yearyear(10/10.000)(10/10.000)

�� 1414--16 % RD < 16 a 16 % RD < 16 a

�� 7070--80 % males80 % males

�� 25% Bilateral RD25% Bilateral RD

Bourges JL. JFrOphtalmol 2001; 24:371-7 Wang NK. Ophthalmology 2005;112:1890-5

Chen SN. et al. Retina. 2006;26:410-4. Bhagat N. J PedOphalmol&Strabismus 2007

EtiologyEtiology

�� 5 causes 5 causes oror riskrisk factorsfactors BiblioBiblio HSJDHSJD�� TraumaTrauma 2323--46% 46% 21%21%

�� Ocular Ocular MalformationMalformation 1212--56% 56% 26%26%

�� MyopiaMyopia 1010--38% 38% 12%12%

�� PreviousPrevious surgerysurgery 88--51%51% 9%9%

�� UveitisUveitis//exudativeexudative diseasesdiseases 1212--15%15% 32%32%

ROP & ROP & RetinoblastomaRetinoblastoma excludedexcluded

Weinberg DV. Ophthalmology 2003;110:1708-13.

TraumaticTraumatic RetinalRetinal DetachmentDetachmentHSJD jan2004HSJD jan2004--dec2008dec2008

1,81,8

1,61,6

2,752,75

1,41,4

22

1,31,3

Nº Nº

surgeriessurgeries

44

1*1*

11

11

3*3*

22

BilateralBilateral

32/1132/11

12/312/3

1/31/3

3/23/2

7/47/4

9/09/0

♂♂//♀♀

4/54/510 a10 a55MyopiaMyopia

9 a9 a

9 a9 a

12 a12 a

3 a3 a

10 a10 a

AgeAge

13/1513/151515Coats, Coats, UveitisUveitis

34/4334/434444TotalTotal

3/43/444Previous Previous

surgerysurgery

8/118/111111Ocular Ocular

malformationmalformation

7/97/999TraumaTrauma

Attached Attached

retinaretinaCasesCases

TraumaticTraumatic RDRD

�� Bilateral: Bilateral: ShakenShaken--babybaby syndromsyndrom

�� Orbital Orbital RxRx/TC: /TC: IntraOcularIntraOcular ForeignForeignBodyBody

�� PenetratingPenetrating traumatrauma

TraumaticTraumatic RD: RD: TreatmentTreatment

�� ScleralScleral surgery surgery (4/9)(4/9)�� Isolated lesions, 2Isolated lesions, 2--10 h10 h

�� Retinal dialysisRetinal dialysis

�� Quick functional recoveryQuick functional recovery

�� Unharmed LensUnharmed Lens

�� Buckle extrusion Buckle extrusion

�� ConjunctivalConjunctival damagedamage

�� DiplopiaDiplopia

�� VitrectomyVitrectomy ++ SB�� Traumatic MHTraumatic MH

�� HemovitreousHemovitreous, PVR>B, PVR>B

�� Intraocular Foreign BodyIntraocular Foreign Body

�� CataractCataract

�� Silicone oilSilicone oil

�� Very bad prognosis Very bad prognosis penetrating traumapenetrating trauma

Ocular Ocular malformationmalformation RDRDHSJD jan2004HSJD jan2004--dec2008dec2008

1,81,8

1,61,6

2,752,75

1,41,4

22

1,31,3

Nº Nº

surgeriessurgeries

44

1*1*

11

11

3*3*

22

BilateralBilateral

32/1132/11

12/312/3

1/31/3

3/23/2

7/47/4

9/09/0

♂♂//♀♀


9 a9 a

9 a9 a

12 a12 a

3 a3 a

10 a10 a

AgeAge




surgerysurgery




Attached Attached


Ocular Ocular malformationmalformation RDRD�� IncreasingIncreasing incidenceincidence

�� SistemicSistemic syndromssyndroms::�� SticklerStickler, , MarfanMarfan, , NorrieNorrie, X , X

linkedlinked retinoschisisretinoschisis

�� Non Non sistemicsistemic syndromssyndroms

�� PersistentPersistent Fetal Fetal VasculatureVasculature, Familial , Familial ExudativeExudativeVitreoretinopathyVitreoretinopathy

� ChorioretinalColoboma

Ocular Ocular malformationmalformation RD: RD: TreatmentTreatment

�� IndividualizedIndividualizedapproachapproach

�� Case Case selectionselection: : PrimumPrimum non non nocerenocere

�� GoodGood anatomicanatomic resultsresults

�� BadBad visual prognosisvisual prognosis

�� Anterior/Mixt PFVAnterior/Mixt PFV

�� ColobomaColoboma

�� FamilialFamilial ExudativeExudativeVitreoretinopathyVitreoretinopathy

�� SticklerStickler

�� Posterior PFVPosterior PFV

�� NorrieNorrie diseasedisease

MyopicMyopic retinalretinal detachmentdetachmentHSJD jan2004HSJD jan2004--dec2008dec2008

1,81,8

1,61,6

2,752,75

1,41,4

22

1,31,3

Nº Nº

surgeriessurgeries

44

1*1*

11

11

3*3*

22

BilateralBilateral

32/1132/11

12/312/3

1/31/3

3/23/2

7/47/4

9/09/0

♂♂//♀♀


9 a9 a

9 a9 a

12 a12 a

3 a3 a

10 a10 a

AgeAge




surgerysurgery




Attached Attached


MyopicMyopic RDRD�� Myopia > 6 Myopia > 6 dpdp

�� 1/5 bilateral RD1/5 bilateral RD

�� 3/5 predisposing 3/5 predisposing lesions lesions contralateralcontralateraleyeeye

�� Good anatomic and Good anatomic and functional resultfunctional result

�� ScleralScleral buckle if buckle if possiblepossible

�� VitrectomyVitrectomy + SB+ SB

�� 3/5 cataract3/5 cataract

PreviousPrevious surgerysurgery RDRDHSJD jan2004HSJD jan2004--dec2008dec2008

1,81,8

1,61,6

2,752,75

1,41,4

22

1,31,3

Nº Nº

surgeriessurgeries

44

1*1*

11

11

3*3*

22

BilateralBilateral

32/1132/11

12/312/3

1/31/3

3/23/2

7/47/4

9/09/0

♂♂//♀♀


9 a9 a

99

aa

12 a12 a

3 a3 a

10 a10 a

AgeAge




surgerysurgery




Attached Attached


PreviousPrevious surgerysurgery RDRD

�� Aphakia/PseudophaAphakia/Pseudophakiakia

�� 10 years after 10 years after surgerysurgery

�� Difficult Difficult FundusFundusexaminationexamination

�� GlaucomaGlaucoma

�� Associated ocular Associated ocular malformationsmalformations

PreviousPrevious surgerysurgery RD RD TreatmentTreatment

�� VitrectomyVitrectomy

�� ScleralScleral BuckleBuckle

�� Silicone OilSilicone Oil

�� Multiple proceduresMultiple procedures

�� Visual prognosis Visual prognosis depending on depending on previous functionprevious function

ExudativeExudative diseasesdiseases & & uveitisuveitis RDRDHSJD jan2004HSJD jan2004--dec2008dec2008

1,81,8

1,61,6

2,752,75

1,41,4

22

1,31,3

Nº Nº

surgeriessurgeries

44

1*1*

11

11

3*3*

22

BilateralBilateral

32/1132/11

12/312/3

1/31/3

3/23/2

7/47/4

9/09/0

♂♂//♀♀


9 a9 a

9 a9 a

12 a12 a

3 a3 a

10 a10 a

AgeAge




surgerysurgery




Attached Attached


UveitisUveitis & & ExudativeExudative diseasesdiseases RDRD

�� ExudativeExudative RD:RD:�� CoatsCoats diseasedisease 10/1510/15

�� LaserLaser, , cryocryo, , transcleraltranscleraldrainagedrainage, , vitrectomyvitrectomy

�� SturgeSturge--WeberWeber RDRD

�� UveitisUveitis RD:RD:

�� TractionalTractional//RhegmatogRhegmatogenousenous

�� IntermediateIntermediate UveitisUveitis

�� VasculitisVasculitis

ResultsResults HSJD jan2004HSJD jan2004--dec2008dec2008

�� Reattachment index 70Reattachment index 70--85 % 85 % (79%)(79%)�� Higher risk Higher risk postsurgicalpostsurgical

PVR PVR �� Need several Need several

proceduresprocedures

�� Limited visual Limited visual recoveryrecovery�� Gain vision Gain vision (60%)(60%)�� AmbliopiaAmbliopia, previous , previous

ocular pathologyocular pathology

�� 23 G 23 G vitrectomyvitrectomy

�� TamponadeTamponade: : airair/SF6//SF6/siliconesilicone oil oil 1000 1000 ctskctsk

�� EnzimaticEnzimatic vitreolysisvitreolysis::�� MicroplasmineMicroplasmine

((recombinantrecombinant))

�� PhasePhase IIIIII

1,81,8

Nº Nº

surgeriessurgeries

34/4334/434432/1132/119 a9 a4444

Attached Attached

retinaretinaBilateralBilateral♂♂//♀♀AgeAgeCasesCases

ConclusionConclusion

�� Bad prognosis factors:Bad prognosis factors:�� Young ageYoung age

�� Delayed diagnosisDelayed diagnosis

�� Associated ocular Associated ocular malformationsmalformations

�� Low VA at diagnosisLow VA at diagnosis

�� Extension RDExtension RD

�� BilateralityBilaterality

Gonzales CR. Retina 2008;28:847-52. Soheilian M. Retina 2008;X:1-7.

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