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  • Scleral buckle can aid retinal reattachment in children

    Pediatric Ophth/Strabismus, Retina/Vitreous

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    This paper describes the importance of scleral buckle in successful repair of pediatric rhegmatogenous retinal detachment (RRD).

    Study design

    This retrospective interventional case series examined data from 212 eyes that underwent surgical repair for RRD between 2001 and 2015 with a minimum follow-up of 3 months (average 36.3 months). Patients were divided into 3 age groups (0–6 years, 7–12 years and 13–18 years) and comparisons were made using bivariate and multivariate generalized estimating equation models.

    Outcomes

    Of 212 eyes, 166 (78%) achieved total reattachment of the retina at final follow-up. Subtotal detachments were more likely than total detachments to be successfully repaired (P=0.01), while eyes with previous vitreoretinal surgery were less likely to undergo successful repair (P=0.03). Surgical success rates did not vary by age group (P=0.55), but was higher with primary scleral buckle and combined buckle/pars plana vitrectomy (PPV) procedures compared with PPV alone.

    Limitations

    This study is limited by its retrospective design. Follow-up for the study was at least 3 months and 85% of patients were followed for 1 year or longer. Nevertheless, patients with worse vision or recurrent RRD may have been more or less likely to follow up than patients with good vision and attached retinas, and it is possible that the results are biased by this variable follow-up.

    Clinical significance

    Previous reviews of pediatric RRD provide useful insight into the anatomic and clinical features of this disease, but part of this analysis was based on surgeries carried out prior to the era of modern vitrectomy techniques. These findings confirm that pediatric RRD is difficult to treat, but successful repair is possible in most patients. Repair of RRD was more successful with primary buckles or combined buckle/PPV compared with primary PPV alone. This is study shows the effectiveness of scleral buckle to repair retinal detachment in pediatric populations and emphasizes the importance of training surgeons to perform this surgery.