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S.J. Young, K.A. Tawansy; Vitreo–Retinal Surgery for Retinal Detachment in Children With Chorioretinal Coloboma . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4093.
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Purpose: Chorio–retinal coloboma carries a risk of complicated retinal detachment as high as 40%, occurring from infancy to adulthood. We sought to evaluate clinical features and anatomic and visual outcomes in a consecutive series of children with retinal detachment and concomitant chorioretinal coloboma. Methods: Retrospective review of patients managed with vitreo–retinal surgery at a children’s retina referral center between 2002 and 2004. Patients ranged in age from 5 weeks to 22 years (mean age 6 years) Results: Ten eyes of ten patients had retinal detachment repair and a follow up of 3 to 24 months. Seventy percent of detachments occurred in males, and 70% involved the left eye. Additional ocular features included 1) morning glory disc anomaly in four eyes, 2) cataracts in five eyes, 3) myopia in two eyes, 4) neovascular glaucoma in one eye, 5) proliferative vitreoretinopathy in four eyes, and 6) microphthalmia in five eyes. Five patients had coloboma in the fellow eye. The retinal detachments were total in 5 eyes and subtotal in 5 eyes. Mechanisms for the detachment included breaks within the coloboma in 7 (70%), traumatic dialysis in 1 (10%), proliferative retinopathy with tractional–exudatuve detachment secondary to peripheral non–perfusion in 1 (10%), and retinal break outside the coloboma in 1 (10%). One of the detachments was found at birth and repaired with primary buckle. This eye developed recurrent detachment at 18 months and required vitrectomy with oil injecion. The majority of eyes (7) were treated with primary scleral buckle and vitrectomy with removal of the posterior hyaloid, internal drainage through the coloboma, endolaser photocoagulation and silicone oil tamponade. One eye was treated with scleral buckle alone, and one eye required vitrectomy with relaxing retinotomy. At a mean follow–up of 8 months, 100% of patients had stable reattached retinas, and none had significant re–proliferation. Post–op visual acuity ranged from 20/1600 to 20/25. Conclusions: Retinal detachments in eyes with chorio–retinal coloboma can occur from breaks within the coloboma, breaks outside the coloboma, and proliferative ischemic retinopathy. Despite prior reports suggesting a high incidence of proliferative vitreo–retinopathy and anatomic failure, our experience in children suggests that the combination of primary scleral buckle with modern vitrectomy, removal of the posterior hyaloid and silicone oil tamponade may result in high reattachment rates.
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