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P. Abeysiri, C. Bunce, R. Sheard, L. da Cruz; Outcomes, complications and casemix of paediatric retinal detachment surgery at Moorfields Eye Hospital . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4065.
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Purpose: To study casemix, functional and anatomical outcome, use of silicon oil and complications of retinal detachment surgery in the paediatric population. Methods: A retrospective observational study of 166 paediatric patients (aged<16) who underwent retinal detachment surgery over a 10 year period (median follow–up 20 months, interquartile range 7–39 months). Results: The casemix comprised of 48% congenital/hereditary, 37% trauma and 14% other aetiologies.Thirty five percent of children had surgery with silicon oil. Outcome was measured functionally as binocular best corrected Snellen visual acuity(BVA) and anatomically as absolute success(attached), qualified success(attached with oil insitu) and failure(partially/ totally detached). Overall BVA was >=6/12 in 72%, 6/18–6/36 in 14% and <6/36 in 14%. In the trauma subgroup these figures were 95%, 2%, 3% respectively.In the congential/hereditary subgroup these figures were 51%, 24.5% and 24.5%. In children having surgery with oil these figures were 58%, 23% and 19%, compared with 80%, 9% and 11% in those without oil (P=0.024). Anatomically surgery was an absolute success was 62% and a relative success in 8%. Overall 17.5% of all children developed cataract, 12.5% developed keratopathy and10% developed glaucoma.Thirty percent developed cataract with oil compared to 9% without oil(OR–4.19, CI–1.75–10, P–0.001), 21% developed keratopathy with oil compared to 8% without oil(OR–3.5, CI–1.27–9.63, P–0.015) and 11% developed glaucoma with oil compared to 10% without oil(OR–1.42, CI–0.43–4.6, P–0.5). Conclusions: Overall more than two thirds of children achieved a binocular vision of >=6/12 following surgery.Children with traumatic detachment achieved significantly better functional vision than those with congenital or hereditary causes, reflecting the bilateral nature and co–existing pathology in the latter.Visual outcome was significantly poorer in children who had oil with a four–fold greater risk of developing cataract and a three–fold greater risk of band keratopathy in this group.Although children undergoing surgery with oil have a worse prognosis due to complex detachments and higher complication rates, 59% acheived binocular vision >= 6/12.
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