Extracto de la presentación sobre desprendimiento de retina en niños expuesto durante el congreso de la Sociedad Europea de Oftalmología Pediátrica (EPOS) en París el 2 y 3 de octubre de 2009. Retinal detachment has a lower incidence in children than in adults. 15 % of all retinal detachments happen in paediatric patients; most of them are in boys and a 25% of the patients develop a bilateral 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-
baby syndrom
Orbital Rx/TC:
IntraOcular Foreign
Body
Penetrating trauma

6. Traumatic RD: Treatment
Scleral surgery (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
Increasing incidence
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 RD Treatment
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 & Exudative diseases 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.

19. MERCI/GRÀCIES
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