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DV Weinberg, AT Lyon, MJ Greenwald, MB Mets; Rhegmatogenous Retinal Detachments in Children: Presenting Features and Surgical Outcomes . Invest. Ophthalmol. Vis. Sci. 2002;43(13):618.
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Purpose: To describe the presenting features and surgical outcomes in a series of children with rhegmatogenous retinal detachments. Method: Patients were identified by chart review at two affiliated tertiary care centers. Risk factors for retinal detachment were classified into 4 categories: 1) congenital or developmental structural ocular abnormalities, 2) trauma, 3) previous ophthalmologic surgery, and 4) preceding uveitis. Results: Thirty-nine eyes of 34 patients, 18 years of age or younger, underwent surgery for rhegmatogenous retinal detachment. Median age was 10 years and 79% of patients were boys. Nine (26%) patients had bilateral retinal detachment at presentation, or developed a detachment in their second eye prior to their 19th birthday. Every eye had at least one risk factor for retinal detachment and over half had risk factors in 2 or more categories. Structural abnormalities were most common (56%). Fifty-one percent eyes had previous surgery, 36% trauma, and 15% uveitis. Detachments tended to be complex. Median follow-up was 24 months. Retinal reattachment was achieved in 79% of eyes, however visual recovery was modest. Median pre and postoperative visual acuities were HM and 20/400, respectively (P=.009). Predictors of a poor visual outcome were: unmeasurable or LP-only pre-operative vision (P=.0002), the presence of PVR (P=.02), Macula-off retinal detachment (P=.01), and the need for vitrectomy surgery (P=.01). Conclusion: Predisposing factors in pediatric retinal detachments, particularly congenital and developmental structural abnormalities, may be more common than previously reported. Modern vitreo-retinal surgical techniques can help achieve retinal reattachment in most cases. Many factors contribute to the limited visual recovery in this patient population. Predictors of visual outcomes are similar to those observed in adults. Inabiltiy of the clinician to confidently determine preoperative visual acuity is a predictor of a poor visual outcome.
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