Visual and Anatomic Outcomes of Pediatric Endoscopic Vitrectomy in 210 Consecutive Cases

Abstract

Purpose : To report on the indications, outcomes, and complications of endoscopic vitrectomy (EV) in a large cohort of pediatric vitreoretinal patients. Prior case series have described endoscopic vitreoretinal surgery predominantly in adult patients with a limited range of indications. Here we describe our experience with EV in a diverse group of patients and pathologies, including those without anterior segment comorbidities.

Methods : Retrospective review of all patients who underwent posterior vitrectomy at Children’s Hospital Los Angeles (CHLA) from 2012-2017. 154 eyes of 125 patients underwent 210 endoscopic vitrectomies using 23-gauge vitrectomy and 19-gauge endoscopy, of which 209 were via the pars plicata/pars plana and 1 was clear corneal. Data collected included demographics, prior ocular histories, pre-operative and post-operative eye exams, and intraoperative techniques. The study was approved by the Institutional Review Board of CHLA (IRB#16-00103).

Results : Out of 210 surgeries on 154 eyes, the most common pre-operative diagnoses were trauma (24%), retinopathy of prematurity (20%), and pars planitis (7%). At presentation, 68% of eyes had no prior surgery (105/154), 23% had 1 prior surgery (36/154), and 8.4% had 2-11 prior surgeries (13/154). Common indications were tractional (107/210; 51%) and rhegmatogenous (60/210; 29%) retinal detachments. Concurrent procedures included silicone oil placement (95/210; 45%), lensectomy (65/210; 25%), and scleral buckling (25/210; 12%). The mean number of surgeries per eye performed at our center was 3.2 (range: 1-11) with a median follow up since last surgery of 4 months (range: 1 month-6 years). Of 103 eyes with pre-operative retinal detachment, including previously operated eyes, anatomic success as defined by retinal attachment with intraocular pressure > 6 mmHg at last follow up was achieved in 63.1% (65/103). The most common postoperative complications were band keratopathy (19/154; 12%) and cataract (14/154; 9%).

Conclusions : In this large series of pediatric endoscopic vitreoretinal surgeries, there were good anatomic outcomes and complication rates comparable to previous studies. The endoscope is a valuable surgical visualization instrument with wide applicability especially in pediatric eyes with complex retinal pathology.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

Image from 20-gauge endoscope showing cutter tip addressing vitreous traction adjacent to lens in eye with ROP stage 4A detachment.