Posterior Vitreous Contracture in Children

Abstract

Abstract: : Purpose: To describe posterior vitreous contracture with resultant tractional retinal detachment in pediatric vasoproliferative retinopathies. Methods: We describe six eyes of six children in whom tractional retinal detachment occurred as result of organization and contraction of the posterior hyaloid as a prominent feature. Patients underwent examination under anesthesia with funduscopic photography (RetCam 120 digital fundus camera). Surgical intervention was undertaken in all cases described. Autologous plasmin assisted vitrectomy was done in one eye. Results: Four eyes are described with retinopathy of prematurity and the remaining two eyes were diagnosed with familial exudative vitreoretinopathy. All of the ROP eyes had undergone prior laser ablation to the peripheral retina. One ROP eye underwent plasmin–assisted vitrectomy. The remaining eyes all underwent standard vitrectomy with lamellar dissection and release of the posterior hyaloid. Conclusions: Identification of posterior vitreous contraction is important in the surgical planning of retinal detachment repair. This is a unique process involving the posterior hyaloid in pediatric eyes with vasoproliferative disease. Surgical repair involves sequential lamellar dissection of formed vitreous sheets along the posterior vitreous. Release of the hyaloid from the retina is difficult and may be aided by autologous plasmin enzyme.

Keywords: retinal detachment • vitreoretinal surgery • vitreous