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Sarah Read, Hassan A Aziz, Ryan Young, Timothy G Murray, Harry W Flynn, Audina M Berrocal; Retinal Detachment in a Pediatric Population: A Retrospective Review of Etiology and Outcome. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3516.
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Retinal detachment (RD), though a relatively common cause of blindness in adults, is rare in the pediatric population. The causes of RD are unique in the pediatric population and can be grouped into tractional (TRD), rhegmatogenous (RRD), and traumatic. This study aimed to explore the epidemiology and outcomes of pediatric RD at a single institution with the aim of clarifying the natural history and prognosis of this disease.
A retrospective review of the medical records of patients 15 years old and younger clinically diagnosed and operated on for RD between 2000-2012.
There were 206 patients included in this study, of which 41 had bilateral RD (total 234 eyes). The average age of diagnosis was 7.4 years and average follow up was 35 months. Of those patients 60 (26%) were grouped as TRD due to retinopathy of prematurity (ROP), persistent fetal vasculature (PFV), and familial exudative vitreoretinopathy (FEVR); 51 (22%) had RRD due to myopia, X-linked retinoschesis (XLRS), or Sticklers syndrome. Traumatic RD was noted in 69 patients (29%). Other causes of RD included Coats disease and coloboma. Patients with a presenting visual acuity (VA) better than 20/200 had a significantly higher chance of better final VA (OR 7.3, p<0.0001). Anatomical success was strongly correlated with VA outcome (OR 103.8, p<0.00001), with only a single patient achieving vision better than 20/200 without anatomical success (0.4%). Anatomical success was significantly more likely in RRD versus TRD (55% vs. 29%, p<0.05) and globe conservation was significantly higher in patients with RRD compared to traumatic or TRD (p<0.05). The rate of obtaining a final VA 20/200 or better was significantly worse in TRD (33%) compared to RRD (70%, p<0.01) or traumatic RD (69%, p<0.05).
This report is one of the first to describe the incidence and outcomes of pediatric retinal detachment due to multiple etiologies presenting at a single institution. ROP and trauma were the most common cause of pediatric RD. RRDs were associated with the best outcomes (anatomic success and globe conservation) where as TRD has the lowest rate of positive visual outcome, indicating that prognosis in pediatric RD is not generalizable across etiology. Though good visual outcome without anatomic success is rare, good anatomic success did not predict visual outcome. This is important when counseling patients and their families.
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