Abstract

SA.19.10

Retinal detachment in children: differential diagnosis and therapy

Meier P.
Klinik und Poliklinik für Augenheilkunde der Universität Leipzig; Universitätsklinikum AöR, Leipzig

The number of retinal detachments in children is rarely compared to number of retinal detachments in adults, only 5% occures in children. The main predisposing factors are trauma, associated conditions (vitreoretinal degeneration, coloboma, PHPV) and myopia. Furthermore retinal detachment in children is idiopathic. These eyes are not associated with any identified associated condition.
We analyzed data from consecutive children (aged 0-18 years) were treated for retinal detachment at our hospital between January 2000 and December 2006. Retinal detachment was found in 83 eyes of 73 children. Retinal detachment was caused in most cases by trauma-associated diseases (32%), followed by idiopathic retinal detachment (15,6%), hereditary vitreoretinal disorders (Morbus Stickler, X-linked juvenile retinoschisis, Kniest-syndrome, familiär exsudative vitreoretinopathy (FEVR)) (9,6%), malformations (persistent hyperplastic primary vitreous, coloboma, microphthalmos) (7,4%), myopia (4,8%), retinopathy of prematurity (ROP) (stage 4 and 5) (12%) and late stage of ROP (4,8%). Just 3 eyes were aphakic or pseudophakic (3,6%), 2 eyes suffered from uveitis (2,4%), and one eye sufferd from Coats’ disease (1,2%).
In summary, vitreoretinal surgery was necessary in 155 cases. 16 eyes were anatomically reattached after buckling surgery. Proliferative vitreoretinopathy was a common problem and in most eyes primary pars plana vitrectomy was necessary. Anatomic reattachment was ultimately accomplished with a mean of 1.9 surgeries per eye in our study. It is important to perform consistent postoperative follow-up.
The functional and anatomical outcomes of retinal detachment in children are less successful than in adults. Further surgical innovations and aetiology-specific treatment strategies are required to improve the outcome in this group. Recent results show that intravitreal use of VEGF inhibitors to treat proliferative retinopathy (ROP, FEVR) in children is effective, but we need further results about safety and side-effects.

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