13.1 Rhegmatogenous Retinal Detachment: Re-detachment Surgery
13.2 Macular Hole Retinal Detachment
13.3 Retinoschisis Detachment
13.4 Optic Disc Pit Retinal Detachment and Maculopathy
13.5 Giant Retinal Tear Detachment
13.6 Retinal Dialysis
13.7 Macular Folds
13.8 Sickle Cell Detachment
13.9 Viral Retinitis Associated Retinal Detachment
13.10 Paediatric Retinal Detachment
Pediatric retinal detachments are complex in part due to their characteristics. When compared to adults, they are more likely to present with worse initial visual acuity, chronic duration and the macula detached. Proliferative vitreoretinopathy (PVR) is more common, reported to be present in 20-60% of cases, partially due to chronicity as well as increased levels of inflammatory mediators. Various predisposing factors to these retinal detachments that must be elucidated with history, imaging and testing (Figure 13.10.1).
Read SP, Aziz HA, Kuriyan A, et al. RETINAL DETACHMENT SURGERY IN A PEDIATRIC POPULATION: Visual and Anatomic Outcomes. Retina. 2018;38(7):1393-1402.
Retinal detachment repair is performed with general anesthesia monitored ideally by a pediatric anesthesiologist. Ancillary testing of both eyes as well as blood samples for genetic testing is facilitated at this time. In specific cases where repeated general anesthesia may be undesirable due to social challenges, or systemic morbidity, immediate bilateral surgery is an option.
Yonekawa Y, Wu WC, Kusaka S, et al. Immediate Sequential Bilateral Pediatric Vitreoretinal Surgery: An International Multicenter Study. Ophthalmology. 2016;123(8):1802-1808.
Anatomical considerations of surgical landmarks must be taken into account. Exposure to the eye is of utmost importance, lateral canthotomy might be necessary for exposure. The sclerotomies are placed according to age and pathology (Table 13.10.1). Pediatric sclera tends to be very tough and trocar entry may be facilitated by holding adjacent sclera or Tenon’s capsule and providing counter traction. If there is a need to remove the lens, or there is concern for iatrogenic retinal breaks with pars plana or pars plicata entry, limbal approach is preferred. Of note, a short trocar system is available from DORC and is especially useful in baby eyes.
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Westmead Eye Manual
This invaluable open-source textbook for eye care professionals summarises the steps ophthalmologists need to perform when examining a patient.