MICROSURGERY OF JUVENILE RETINAL-DETACHMENT

We conducted a retrospective study of 84 retinal detachments in 69 consecutive children under 1.5 years of age, operated using microsurgical techniques. The goal of this study was to evaluate the prognosis following this surgical approach. Trauma was the most frequent etiology (34.6% of eves), followed by high myopia (31% of eves). The other etiologies were varied. Cicatricial retinopathy of prematurity was the most common of them (9.5% of eyes). The series was characterised by the severity of retinal detachment at initial presentation with total retinal detachment in 44% of eves, detached macula in 70.3% of eves and severe PVR in 29.8% of eyes. Sixty nine of the 84 eyes were operated on. Thirty two eves were managed using transscleral microsurgery and 37 eyes (53.6%) required vitrectomy. Permanent retinal reattachment was achieved in 51 of the 69 eyes (73.9%). The present series of retinal detachments in children was highly heterogenous. Retinal detachments related to retinogenic retinal breaks (atrophic holes and oral dialyses) were more common compared with adult retinal detachments. Their prognosis after surgery was excellent. In contrast traction retinal detachments and detachments related to vitreogenic retinal tears were characterised by a more guarded prognosis. However microsurgical techniques have made the most severe cases, such as grade D2-D3 PVR, giant tears with an inverted posterior flap and detachments after penetrating eye injuries, amenable to surgical management with encouraging results.