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Pediatric retinal detachment
- 1. Pediatric retinal detachment:a survey from a pediatric hospital Jaume Català Mora Jesús Díaz Cascajosa Joan Prat Bartomeu
- 2. Introduction Low incidence 3/10.000/year (10/10.000) 14-16 % RD < 16 a 70-80 % males 25% Bilateral RD Bourges JL. JFrOphtalmol 2001; 24:371-7 Wang NK. Ophthalmology 2005;112:1890-5 Chen SN. et al. Retina. 2006;26:410-4. Bhagat N. J Ped Ophalmol&Strabismus 2007
- 3. Etiology 5 causes or risk factors Biblio HSJD Trauma 23-46% 21% Ocular Malformation 12-56% 26% Myopia 10-38% 12% Previous surgery 8-51% 9% Uveitis/exudative diseases 12-15% 32% ROP & Retinoblastoma excluded Weinberg DV. Ophthalmology 2003;110:1708-13.
- 4. Traumatic Retinal Detachment HSJD jan2004-dec2008 Nº Attached Cases Age ♂/♀ Bilateral surgeries retina Trauma 9 10 a 9/0 2 1,3 7/9 Ocular malformation 11 3 a 7/4 3* 2 8/11 Myopia 5 10 a 3/2 1 1,4 4/5 Previous surgery 4 12 a 1/3 1 2,75 3/4 Coats, Uveitis 15 9 a 12/3 1* 1,6 13/15 Total 44 9 a 32/11 4 1,8 34/43
- 5. Traumatic RD Bilateral: Shaken- babysyndrom Orbital Rx/TC: IntraOcular Foreign Body Penetrating trauma
- 6. Traumatic RD: Treatment Scleralsurgery (4/9) Vitrectomy + SB Isolated lesions, 2-10 h Traumatic MH Retinal dialysis Hemovitreous, PVR>B Quick functional recovery Intraocular Foreign Body Unharmed Lens Buckle extrusion Cataract Conjunctival damage Silicone oil Diplopia Very bad prognosis penetrating trauma
- 7. Ocular malformation RD HSJD jan2004-dec2008 Nº Attached Cases Age ♂/♀ Bilateral surgeries retina Trauma 9 10 a 9/0 2 1,3 7/9 Ocular malformation 11 3 a 7/4 3* 2 8/11 Myopia 5 10 a 3/2 1 1,4 4/5 Previous surgery 4 12 a 1/3 1 2,75 3/4 Coats, Uveitis 15 9 a 12/3 1* 1,6 13/15 Total 44 9 a 32/11 4 1,8 34/43
- 8. Ocular malformation RD Increasingincidence Sistemic syndroms: Stickler, Marfan, Norrie, X linked retinoschisis Non sistemic syndroms Persistent Fetal Vasculature, Familial Exudative Vitreoretinopathy Chorioretinal Coloboma
- 9. Ocular malformation RD: Treatment Individualized Anterior/Mixt PFV approach Coloboma Case selection: Familial Exudative Primum non nocere Vitreoretinopathy Good anatomic results Stickler Bad visual prognosis Posterior PFV Norrie disease
- 10. Myopic retinal detachment HSJD jan2004-dec2008 Nº Attached Cases Age ♂/♀ Bilateral surgeries retina Trauma 9 10 a 9/0 2 1,3 7/9 Ocular malformation 11 3 a 7/4 3* 2 8/11 Myopia 5 10 a 3/2 1 1,4 4/5 Previous surgery 4 12 a 1/3 1 2,75 3/4 Coats, Uveitis 15 9 a 12/3 1* 1,6 13/15 Total 44 9 a 32/11 4 1,8 34/43
- 11. Myopic RD Myopia >6 dp 1/5 bilateral RD 3/5 predisposing lesions contralateral eye Good anatomic and functional result Scleral buckle if possible Vitrectomy + SB 3/5 cataract
- 12. Previous surgery RD HSJD jan2004-dec2008 Nº Attached Cases Age ♂/♀ Bilateral surgeries retina Trauma 9 10 a 9/0 2 1,3 7/9 Ocular malformation 11 3 a 7/4 3* 2 8/11 Myopia 5 10 a 3/2 1 1,4 4/5 Previous surgery 4 12 a 1/3 1 2,75 3/4 Coats, Uveitis 15 9 12/3 1* 1,6 13/15 a Total 44 9 a 32/11 4 1,8 34/43
- 13. Previous surgery RD Aphakia/Pseudopha kia 10 years after surgery Difficult Fundus examination Glaucoma Associated ocular malformations
- 14. Previous surgery RDTreatment Vitrectomy Scleral Buckle Silicone Oil Multiple procedures Visual prognosis depending on previous function
- 15. Exudative diseases &uveitis RD HSJD jan2004-dec2008 Nº Attached Cases Age ♂/♀ Bilateral surgeries retina Trauma 9 10 a 9/0 2 1,3 7/9 Ocular malformation 11 3 a 7/4 3* 2 8/11 Myopia 5 10 a 3/2 1 1,4 4/5 Previous surgery 4 12 a 1/3 1 2,75 3/4 Coats, Uveitis 15 9 a 12/3 1* 1,6 13/15 Total 44 9 a 32/11 4 1,8 34/43
- 16. Uveitis & Exudativediseases RD Exudative RD: Coats disease 10/15 Laser, cryo, transcleral drainage, vitrectomy Sturge-Weber RD Uveitis RD: Tractional/Rhegmatog enous Intermediate Uveitis Vasculitis
- 17. Results HSJD jan2004-dec2008 Nº Attached Cases Age ♂/♀ Bilateral surgeries retina 44 9a 32/11 4 1,8 34/43 Reattachment index 70- 23 G vitrectomy 85 % (79%) Higher risk postsurgical Tamponade: PVR air/SF6/silicone oil Need several 1000 ctsk procedures Enzimatic vitreolysis: Limited visual Microplasmine recovery (recombinant) Gain vision (60%) Phase III Ambliopia, previous ocular pathology
- 18. Conclusion Bad prognosis factors: Young age Delayed diagnosis Associated ocular malformations Low VA at diagnosis Extension RD Bilaterality Gonzales CR. Retina 2008;28:847-52. Soheilian M. Retina 2008;X:1-7.
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